Elizabeth, 28, is referred by her family practitioner with a note that her MRI report is suggestive of MS. She is married with two children and is currently employed as a middle school teacher. She has a history of episodic migraine but is otherwise healthy. She reports no neurological symptoms. There is no history of recreational drug use. There is no family history of demyelinating diseases including MS. Elizabeth tells you she has a maternal aunt with fibromyalgia.
The neurological examination is normal. A non-contrast MRI brain shows approximately 15 T2 hyperintense lesions: four periventricular, two juxtacortical, two in the corpus callosum, one in the middle cerebellar peduncle and the rest in the subcortical white matter.