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R.M. is a 24-year-old woman who works at a daycare centre. She is referred from the emergency room because of a two-week history of paresthesiae in both legs and the mid and lower trunk. She is not aware of any weakness. There is no bladder disturbance. She has a subjective mid truncal sensory level. Prior history includes a Bell’s palsy three years ago which was painless and resolved without treatment in 3-4 weeks.
On examination she has pallor of the left optic disc with intact vision. There is no abnormality of extraocular movements and no residual facial weakness. There is no objective sensory level. She has mild loss of distal vibration at the great toes. She has a left extensor plantar. EDSS is 1.5. MRI of the spine shows a non-enhancing short segment lesion laterally at C3 and an enhancing short segment posterior lesion at T3.
Subsequent MRI of the brain shows four characteristic supratentorial lesions, a mid pontine lesion, and a cerebellar peduncle lesion. None of the brain lesions enhance. Her symptoms resolve completely in five weeks with no treatment. Repeat examination is unchanged. Routine blood work is unremarkable. She is non-immune to measles and hepatitis B.