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A Teenager with Leg Weakness A 17 year old girl saw a physician because of a five day history of weakness and on-and-off tingling sensation and muscle spasm of the right leg. These symptoms are brief, about five times a day, not associated with any activity, and it happens any time of the day. When she is moving around, the symptoms seem to go away faster. She has no headache, vomiting, dizziness, blurring of vision, loss of consciousness, belly pain, pain on urination, joint symptoms, or rashes. She denies of taking drugs. At three years old she had minor head injury. There was no history of migraine or other neurological problems in the family. She is an articulate and cooperative young lady. All of the vital signs were normal. Her neurological examination was also normal. No abnormalities were found in the complete blood count and blood chemistries. Discussion: The possibilities or differential diagnosis considered in the patient were: collagen vascular disease such as systemic lupus, Lyme disease, viral encephalitis, multiple sclerosis, and brain tumor. Tests for systemic lupus called ANA and Lyme test were both normal. The MRI of the head showed multiple high signal lesions in the white matter of both cerebral hemispheres consistent with multiple sclerosis (MS). MS is a disease of the central nervous system that affects young adults between 20 to 40 years old, although it has been reported in very young children. The clinical symptoms vary from weakness, reduced fine motor skills, abnormality in walking, optic neuritis, double vistion, sensory changes, and ataxia. Sometimes the symptoms can be so mild that it would go unnoticed. The symptoms can sometimes come and go or it could be a progressive one. There is no definitive test that could diagnose MS. To make a diagnosis, there must be objective evidence of two signs consistent with demyelination, separated by an interval of about one month. These neurological signs must involve two anatomically separate areas of the central nervous system. A neurologist usually makes the diagnosis of MS. MS is a chronic progressive, disabling disease causing more than 80% of patients to have some functional limitation about 15 years after the diagnosis. There is no specific treatment, however, interferon beta-1a (Avonex) has been shown in clinical trials to reduce fewer exacerbations and fewer new abnormalities in the brain MRI. Leo Leonidas, MD, FAAP
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