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Clinical Crossroads
October 28, 1998

A 29-Year-Old Man With Multiple Sclerosis

Author Affiliations

Dr Rudick is Director, Mellen Center for Multiple Sclerosis Treatment and Research, Professor of Neurology, Cleveland Clinic Foundation, and Professor of Neurology, Ohio State University, Cleveland.


Clinical Crossroads at Beth Israel Deaconess Medical Center is produced and edited by Thomas L. Delbanco, MD, Jennifer Daley, MD, and Richard A. Parker, MD; Erin E. Hartman, MS, is managing editor. Clinical Crossroads section editor: Margaret A. Winker, MD, Senior Editor, JAMA .

JAMA. 1998;280(16):1432-1439. doi:10.1001/jama.280.16.1432

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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