Harrison's PodClass: Internal Medicine Cases and Board Prep Ep 170: A 35-Year-Old with Changes in Vision
Oct 30, 2025
Dr. Andrew Josephson, a neurology expert and editor at Harrison’s, joins to discuss multiple sclerosis and its connection to optic neuritis. He breaks down symptoms like visual changes and the significance of afferent pupillary defects. Josephson highlights that MS is more prevalent in women 20-40 and often begins with sensory issues. He outlines diagnostic methods such as MRI and emphasizes the importance of early treatment to prevent disability. Tune in for valuable insights into diagnosing and managing these complex conditions!
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Recognizing Optic Neuritis
- Optic neuritis presents with painful eye movement, decreased acuity, and an afferent pupillary defect without fundoscopic changes.
- These features strongly point to inflammation of the optic nerve rather than primary ocular surface disease.
Linking Sensory Symptoms To CNS Disease
- Sensory symptoms like paresthesias and transient numbness alongside optic neuritis suggest a disseminated CNS process.
- These disparate neurologic episodes (past and present) raise concern for multiple sclerosis rather than isolated peripheral problems.
Prior Transient Neurologic Episode
- The patient recalled a resolved episode 18 months earlier of severe lateral leg and abdominal pain with transient foot numbness and weakness.
- That prior self-limited neurologic event supports a relapsing process rather than a single isolated insult.
