Multiple Sclerosis Case 1

A previously healthy 28-year-old man presents to the ED with pain in his left eye. The pain has developed over the past 4-6 hours and is made worse with moving his eye. He has also noticed that eye movements are associated with a sensation of flashing lights. He describes colours as being dull and an overall sensation of blurred vision.

On examination there is a diminished afferent pupillary response to light, a decrease in visual acuity, and a diminished central visual field (scotoma). The optic disc is however normal.

The patient describes a similar milder episode 8 months previously that resolved entirely in 2 days for which he did not receive any medical attention.

You make a clinical diagnosis of optic neuritis. In relation to this patient:

Select the statements which are true.

As this patient has recurrent symptoms of optic neuritis, you suspect this may be a presentation of MS. On direct questioning, the patient reports symptoms of worsening fatigue for 18 months, which his general practitioner has attributed to work-related stress. During the previous summer, he had a one-week episode of tingling and weakness in his right arm, which settled spontaneously. Full neurological examination is otherwise unremarkable other than a fine resting tremor in the left hand.

Which of the following statements are correct?