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Risha Hertz [1] and James Espinosa [2] and Alan Lucerna [2] and Doug Stranges [2]
Academic Editor: Peter Berlit
1, University of Pennsylvania Health System, Penn Medicine, Gibbsboro, NJ, USA, pennmedicine.org
2, Department of Emergency Medicine, Rowan University SOM, Stratford, NJ, USA, rowan.edu
Received May 31, 2017; Accepted Aug 8, 2017
This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
1. Introduction
Multiple sclerosis (MS) is a chronic inflammatory demyelinating disease of the central nervous system. The etiology is insufficiently understood. Most common causes are thought to be related to autoimmune, genetic, viral, and environmental factors. MS is twice as common in women as in men between the ages of 20–50 years. There is no known cure for MS. Current medical treatment helps to prevent new attacks and improve function after an attack. MS is diagnosed by physical examination, diagnostic testing including imaging, and examination of cerebral spinal fluid. The most common physical signs and symptoms of MS include constitutional symptoms, muscle weakness, motor and autonomic spinal cord symptoms, paresthesias, and vision changes.
2. The Case
A 33-year-old male presents with several weeks of what he described as spasms of his left eyelid which progressed to episodes of twitching of his left eye and left cheek. A comprehensive review of systems was negative. He denied history of tobacco, drug, or alcohol abuse. His past medical history included gastroesophageal reflux disease and osteogenesis imperfecta. His past surgical history and family history were noncontributory. He did not take any prescribed, herbal, or over the counter medications. He drank one to two cups of coffee daily. His vital signs were within normal limits. His vital signs were normal on presentation. He was orientated to person, place, and time and well-developed, well nourished, and in no distress. Spasms were noted of his left eyelid with several brief episodes of left hemifacial spasm. His physical exam was otherwise within normal limits.
Diagnostic testing included magnetic resonance imaging (MRI) of the brain, magnetic resonance angiogram (MRA) of the head and neck, complete blood count with differential, comprehensive metabolic panel, magnesium, phosphorus,...