This is a 25-year-old, right handed female, who has had visual changes for one month. The first symptom was trouble reading; specifically, that half of the words on the right were missing. While reading the newspaper she would need to turn her head to finish a line or a sentence. The right visual field was "dark and blurry." No diplopia. She was referred to an ophthalmologist who found mild myopia and normal visual field testing.
The visual problems slowly progressed and new symptoms surfaced. These include word substitutions (paraphasias), dizziness, and transient leg numbness. The dizzy feeling is "off balance" noted with position change. She denies vertigo, tinnitus, hearing trouble, or gait difficulties. Two episodes of leg numbness each lasted 30 secs. The first involved both legs and the second only part of the left leg.
A repeat eye exam three days ago revealed a right superior visual field deficit on computerized testing.
Review of systems is positive for a dog bite on the forehead approximately
six to eight months ago, inability to drive and poor work performance.
She denies headache, eye pain, limb weakness, permanent numbness, dysarthria,
history of seizures, and bowel or bladder change. Two years ago the patient
had mild numbness in her right
PMH: Right orbital fracture repair at age 8.
Family History: Father was diagnosed with multiple sclerosis at age 35 and died from this disease.
Social History: Works as a private investigator. Single. Rare alcohol. No smoking or illicit drugs.