Case Study on Multiple Sclerosis: Risk Factors, Aetiology, and Nursing Interventions

Running head- CASE STUDY
Assessment Task 1
Name of the Student
Name of the University
Author Note

1CASE STUDY
Multiple sclerosis (MS) refers to a neurological condition that is potentially disabling
and affects the brain and the spinal cord. In MS, the host’s immune system attack the
shielding myelin or medullary sheath that is found to cover the nerve fibres facilitate
communication between the brain and entire body. Eventually, the neurological disease can
results in a deterioration of the nerves that become permanently damaged. The common signs
and symptoms of this condition vary extensively and are subjected to the extent of nerve
damage and the specific nerves that are affected. Some of the most common manifestations
of MS encompass weakness and numbness in one or both limbs that are found to typically
occur at one part of the body (Lublin et al. 2014). Complete or partial loss of vision is also
found among the patients, in addition to pain and tingling sensation in different parts of the
body. Furthermore, most patients suffering from MS report relapses in their health condition
and experience newer symptoms that last over several weeks and days, and usually get
improved completely or partially. This assignment will discuss a case study of a MS patient
and will critically evaluate her risk factors and aetiology with the presenting complaints.
MS is identified as one of the most common neurological disease that affects more
than a million individuals on a global scale. The disease usually begins in adult life (20-
45years) and results in a progressive disability among people in several decades.
Furthermore, it is more common in females than males, in the ratio 2:1 (MyVMC 2018). The
prevalence of the disorder is considered directly proportional to the distance of the affected
people from the equator. The prevalence is an estimated 60-100/100,000 person at 50-65
degrees latitude and is rarely found at the Equator. There were an estimated 23,700
Australians with MS in the year 2009, and of them 48% or 11, 400 suffered from severe
forms of the condition (Abs.gov.au 2018).
The patient X (pseudonym), aged 40 years had been first diagnosed with MS in the
year 2014. She had recently given birth to a child and was a breastfeeding mother. Some of

2CASE STUDY
the most common symptoms that she had experienced during that time were visual
disturbances and a feeling of fatigue and tiredness. However, she attributed these symptoms
to her recent pregnancy and its subsequent impact on lack of sleep. With a deterioration of
her symptoms, she consulted a neurologist. Weakness is one of the most common symptoms
of MS. Fatigue and weakness are closely associated and presence of one symptom often
deteriorates another. MS commonly presents in the form of weakness in the legs, generally
referred to as monoparesis (one leg) or paraparesis (both legs), thereby resulting in problems
with maintaining balance and walking (Wagner et al. 2014). Injury to the nerves result in a
slowing down or disruption of messages, primarily within the spinal cord, thereby making it
tougher to effectively move the muscles. These weaknesses come and go with the remissions,
during the course of the neurological condition (Hoang, Gandevia and Herbert 2014).
On the other hand, vision changes in the patient were accurately diagnosed as optic
neuritis that is commonly exhibited in the form of blurry or double vision at some point of
their lives. Vision changes are a major adjustment that occur in MS. These disturbances
might affect one or both the eyes. There occurs a worsening of the problem, which might
later disappear as well (Balcer et al. 2014). An assessment of her visual condition confirmed
the onset of optic neuritis that generally develops when there is a breakdown of the protective
coat that surrounds the optic nerve. With an increase in demyelination, the symptoms of MS
deteriorate, which is evident in the case study as well (Kaufhold et al. 2013). Furthermore, a
lesion was also found in the MRI reports. Multiple sclerosis is characteristically diagnosed on
the presenting symptoms and signs, in combination with different laboratory testing
and medical imaging (Krupp et al. 2013). Although the early signs and symptoms are in
accordance to a range of other medical complications, presence of a lesion, as evidenced by
MRI was a correct diagnosis. Owing to the fact that X was a breastfeeding mother, she
decided to refuse treatment for MS and opted to have another child.

3CASE STUDY
The pathophysiology of MS comprises of three major component namely, a lesion in
the CNS, inflammation and destruction of the medullary sheath that surrounds the neurons.
Plaques or lesions commonly affect the basal ganglia, optic nerve white matter and the spinal
cord, in addition to the white matter regions present near the lateral ventricles. Progressive
loss of oligodendrocytes that are responsible for maintaining and creating a layer of fatty
tissue, leads to complete or partial loss of myelin with an advancement of the disease (Solaro,
Trabucco and Uccelli 2013). With a loss of myelin sheath, the neurons fail to effectively
transmit nerve signals. Attack of the myelin sheath begins the inflammatory process that
leads to the release of cytokines and several antibodies. Breakdown of the blood-brain barrier
also leads to a plethora of other detrimental effects such as, activation of macrophage,
swelling, and activation of cytokines.
Following breastfeeding the second child for few months, she began the treatment and
was under the administration of Tysabri infusion of 300mg, IV, for every 28 days. Tysabri or
natalizumab is a prescription medicine, commonly used for treating adults with relapsing
multiple sclerosis, and helps in slowing down the rate of worsening of indications and
reducing the number of relapses or flare-ups. Research evidences have established the role of
the medication in reducing the progression of the neurological disability among patients
(Butzkueven et al. 2014). Furthermore, when used in combination with IB1A, reduction of
visual loss, increase in number of MS free patients and enhanced assessments of their health
associated quality of life have also been observed (Kamm, Uitdehaag and Polman 2014).
Further advantages of Tysabri are associated with a reduction in cognitive decline among
individuals with MS, with subsequent reduction in rates of hospitalizations and use of
steroids.
Furthermore, the drug is also approved in the European nation and the US to be used
in the form of monotherapy, with the aim of treating active and relapsing MS, despite