Physical Findings

Stop & Think

Lab and X-Ray

Differential Diagnosis

The Disease

Treatment

Conclusions

Quiz & Evaluation

• Multifocal lesions of the white matter are evident on MRI.
• CBC and chemistry values don't point to anything in particular.
• Immunology panel seems to rule out lupus
• Even though we have "normal" coagulation studies, we can't rule out transient ischemic attacks (TIAs).
• TIAs are likely the result of transient platelet plugs, and we've done nothing to assess platelet function.
• The cerebral spinal fluid IgG, and especially the IgG index, are troubling.

We need a detailed look at the CSF gamma protein .          Back