Diagnosing primary progressive multiple sclerosis

Abstract

A 56-year-old man with a history of asthma and anxiety presented for further evaluation of his ongoing neurological decline. He reported being in good neurological health until a few years ago, when he developed left hand clumsiness followed by some difficulty ambulating due to fatigable weakness in his left leg. He noticed that his left leg would become weak while walking long distances but then would improve after resting. These symptoms prompted neurophysiological studies that demonstrated mild bilateral median neuropathies at the wrist, which was thought to be contributing to his hand symptoms. Lower extremity neurophysiological testing did not reveal a polyneuropathy, myopathy, or radiculopathy. He subsequently underwent a lumbar spine MRI for his ambulation difficulties that demonstrated some degenerative disk disease, but no spinal stenosis or nerve root compression.