Click here to watch Dr. Courtney Casserly discuss the case and the responses to the survey.
J.M. is a 28-year-old woman who had an MRI of the brain ordered by her nurse practitioner because of worsening of longstanding migraine headaches. The MRI demonstrated several lesions consistent with MS including two small enhancing lesions and multiple nonspecific supratentorial T2 hyperintensities. Your review of the history reveals nothing suggestive of a demyelinating episode. There is no family history of MS. She has an older brother with ulcerative colitis. The neurological examination was completely normal with borderline questionable pallor of the left optic disc.