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Clinical Crossroads |

A 29-Year-Old Man With Multiple Sclerosis

Richard A. Rudick, MD, Discussant
JAMA. 1998;280(16):1432-1439. doi:10.1001/jama.280.16.1432.
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DR DELBANCO: Mr J is a 29-year-old, married engineer who works in a biomedical laboratory. He was found to have multiple sclerosis (MS) 14 months prior to this conference. Shortly thereafter, he sought care from a general internist, Dr C, at the Beth Israel Deaconess Medical Center and a neurologist at another medical center. He has health insurance through a commercial managed care plan.

A few months after Mr J developed Bell palsy, which resolved fully, he noted weakness in his right leg while skiing. The weakness progressed, and he consulted a neurologist when he returned home. Physical examination and magnetic resonance imaging (MRI) were compatible with demyelinating disease. During the subsequent year, Mr J noted slowly progressive weakness associated with exercise, again primarily involving the right leg. He experienced some difficulty with urination, in both initiating and ending the stream. He observed some tremor in his right foot. He experienced difficulty with sexual function on occasion, but his bowels have not been affected. There has never been diplopia or evidence for involvement in other parts of the body.

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Graphic Jump Location
Figure 1.—Representative image from Mr. J's magnetic resonance imaging scan. The photograph is an axial image just superior to the lateral ventricles, showing typical round and ovoid T2 hyperintensities in the periventricular white matter and corpus callosum.
Graphic Jump Location
Figure 2.—Representative image from Mr J's magnetic resonance imaging scan. The photograph is a midsagittal FLAIR image showing typical T2 hyperintense lesions in the body of the corpus callosum.



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