Physician Neglects To Perform MRI On Patient With Symptoms Of Multiple Sclerosis

Case Overview

This case involves a healthy female patient who presented with tingling in her legs and episodes of blurry vision and eye pain. The physician suspected multiple sclerosis and performed a CT. The CT read as negative and no further workup or follow up was performed. Over the next 4 months, the patient had recurring and worsening symptoms, particularly in her legs. The patient returned to the hospital after an acute flare-up in her leg numbness caused her to lose her balance and fall. The neurologist who saw the patient immediately performed an MRI which revealed the patient had several multiple sclerosis plaques. A few years after receiving her diagnosis, the patient experienced difficulty swallowing and frequent hand tremors. An expert in neurology was sought to opine on the standard of care for patients who present with symptoms of multiple sclerosis and discuss how a delay in diagnosis and treatment can impact the outcome of such patients.

Questions to the Neurology expert and their responses

Briefly describe your experience treating patients with multiple sclerosis.

I care for about 150 MS patients in an ongoing way and therefore I am very familiar with the standard of care and protocols for treating MS patients and diagnosing MS.

What is the standard of care for initiating treatment of a patient with one episode of multiple sclerosis symptoms?

The standard of care for probable or definitive MS is to start a disease-modifying therapy. The standard of care in CIS is less clear and is an evolving question. Most MS specialists would treat CIS if it is high risk.

If treatment is not initiated after one episode, what is the standard of care in terms of referral to a specialist for monitoring symptoms?

If a patient with CIS or suspected MS isn't treated, then screening MRIs are indicated at regular intervals to make sure there is no further radiologic evidence of injury.

How can delay in treatment impact outcome in patients with multiple sclerosis?

Disease-modifying therapies decrease the rate of relapses in MS and relapses can have permanent sequelae. In addition, long-term treatment with these drugs decreases the long-term accumulation of disability.

About the expert

This highly qualified expert has over 30 years of experience with neurology. He attended the University of Toronto where he gained a BS in science and zoology, an MS in molecular neurochemistry, as well as an MD. He went on to complete an internal medicine internship at Sunnybrook Medical Centre, residencies in neurology, neuropathology, and neurophysiology at Toronto General Hospital, and a residency in pediatric neurology at the Hospital for Sick Children. Today, this expert is board-certified in neurology and an active member of several societies including the Royal College of Physicians and Surgeons of Canada, the Canadian Neurological Society, the American Society for Neurological Investigation, and the International Society for Neuroimmunology to name a few. Formerly, this expert served as an assistant professor of neurology as well as microbiology and immunology at McGill University, the head of the EEG department at Brockville Psychiatric Hospital, and a staff neurologist at four local hospitals in Montréal. Currently, he is a professor of neurology, microbiology, immunology, and biochemistry at an Ontario university, the director of multiple sclerosis research at a university-affiliated hospital, and a senior scientist at a research university in Ontario.

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Specialties:

Neurology

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