Clinical Case Database / Category: Patient Management

Investigation and management of a possible first presentation of multiple sclerosis

Publication details

Dr David Paling, Dr Tahir Majeed
Foundation Years Journal, volume 4, issue 3, p.8 (123Doc Education, London, March 2010)


This case presents the investigation and management of a patient with a first episode of neurological dysfunction that could be the first presentation of multiple sclerosis. A discussion of the rationale for the investigations and treatment follows, and we discuss communication with a patient and planning for her long-term care.

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Dr David Paling

Dr David Paling
SpR in Neurology
Institute of Neurology
National Hospital for Neurology and Neurosurgery
Queen Square

Dr Tahir Majeed

Consultant in Neurology
Royal Preston Hospital


1. Al-Araji AH, Oger J. Reappraisal of Lhermitte's sign in multiple sclerosis. Mult Scler, 11:398 402.
2. Coles A (2009) Multiple Sclerosis: the bare essentials. Pract Neurol, 9:118–126.
3. Polman CH, Reingold SC, Edan G, et al. (2005) Diagnostic criteria for multiple sclerosis: 2005 revisions to the "McDonald Criteria". Ann Neurol, 58:840–846.
4. Fisniku LK, Brex PA, Altman DA, et al. (2008) Disability and T2 MRI lesions: a 20-year follow up of patients with relapse onset of multiple sclerosis. Brain, 131:808–817.
5. Tintoré M, Rovira A, Río J, et al. (2008) Do oligoclonal bands add information to MRI in first attacks of multiple sclerosis? Neurology, 70:1079–1083.
6. Filippini G, Brusaferri F, Sibley WA, et al. (2000) Corticosteroids for acute exacerbations in multiple sclerosis. Cochrane Library, (4). Oxford: Update Software.
7. Koopman W, Schweitzer A (1999) The journey to multiple sclerosis: a qualitative study. J Neurosci Nurs, 31:17–26.
8. National Institute for Clinical Excellence (2003) Management of multiple sclerosis in primary and secondary care. London: NICE.
9. Stewart MA (1995) Effective physician-patient communication and health outcomes: a review. Can Med Assoc J, 152:1423–1433.
10. Leary SM, Porter B, Thompson AJ (2005) Multiple sclerosis: diagnosis and the management of acute relapses. Postgrad Med J, 81:302–308.


Conflict Of Interest

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Financial Statement

The authors of this article have not been paid. The Journal is financed by subscriptions and advertising. The Journal does not receive money from any other sources. The decision to accept or refuse this article for publication was free from financial considerations and was solely the responsibility of the Editorial Panel and Editor-in-Chief.

Patient Consent statement

All pictures and investigations shown in this article are shown with the patients’ consent. We require Authors to maintain patients’ anonymity and to obtain consent to report investigations and pictures involving human subjects when anonymity may be compromised. The Journal follows the Guidelines of the Uniform Requirements for Manuscripts ( The Journal requires in its Guidelines for Authors a statement from Authors that “the subject gave informed consent”.

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When reporting experiments on human subjects, the Journal requires authors to indicate whether the procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the HelsinkiDeclaration of 1975, as revised in 2008.

About the Clinical Cases Database

T​he Foundation Years Clinical Cases Database is​ a selection of 600 peer-reviewed clinical cases in the field of patient safety and clinical practice, specifically focused on the clinical information needs of junior doctors, based around the Foundation Year Curriculum programme (MMC). The cases have been chosen to align with the Foundation Year Curriculum.

The database is fully searchable, or can be browsed by medical specialty. Abstracts can be read free of charge, however a subscription is required in order to read the complete cases.