A 22-year-old female college student, MS. Ulrie, presents will along

A 22-year-old female college student, MS. Ulrie, presents will along with upper extremity weakness and tingling and numbness in both hands. Ms. Ulrie is worried that she might have multiple sclerosis (MS) because her maternal grandmother had this disorder. On neurologic examination, she has blurry vision in the right eye, motor weakness, and a feeling of “pins and nee- dles” in both hands. Blood test results are normal, including hemoglobin con- centration, overall and differential white cell count, erythrocyte sedimentation rate, vitamin B,2 and folate levels, and syphilis serology. Magnetic resonance imaging (MRI) reveals one to two periventricular demyelinated plaques. The cerebrospinal fluid (CSF) extracted by lumbar puncture contains normal amounts of protein (0.40 mg per dayL) and lymphocytes (three cells observed in the sample). Further analysis of the CSF by gel electropho- resis reveals the presence of multiple oligoclonal bands. These bands represent specific types of immunoglobulins and are rare in people who do not have MS or a similar inflammatory disorder of the central nervous system. The presence of oligoclonal bands in the CSF is a strong indicator of Ms. Ulrie’s symptoms and test results are consistent with a diagnosis of MS.

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