Amy Sandberg ihuman Urinary Incontinence

Reason for Encounter

Urinary incontinence

History of Present illness (HPI)

Amy Sandberg is a 42-year old female presenting for evaluation of urinary incontinence, worsening fatigue, and visual disturbances. The first time she had urinary incontinence was 6 months ago when she had the urge to urinate. The second time was recently when she just leaked urine despite having an empty bladder. The amount of urine she leaks is enough to wet her pants. In the past 3 months, she has lacked energy and isn’t as coordinated as before. Her legs feel tired, heavy and occasionally unresponsive. When she sits longer, she experiences strange weakness and unsteadiness in her legs. Other times, she gets “pins and needles” feelings which began 3 months ago. The fatigue doesn’t improve after a good night rest. She also reports few episodes of visual disturbances over a few hours to a few days lasting not more than 20 minutes. She denies pain in the lower back, nocturia, flank pain, frequency, urgency, blood or foul odor in urine, fevers, pain or burning with urination.

Case Findings

Urinary Incontinence x2 last 24 hours
Intermittent, bilateral LE weakness, unsteadiness
Intermittent blurred visionx3 weeks
Bilaterally symmetrical hyperreflexia (without clonus) throughout UE and LE DTR evaluation
Slight bilateral symmetrical, diminished UE strength (4/5)
Clear bilateral symmetrical, diminished LE strength (3/5)
Bilateral paresthesia x 3months
Fatigue x 6months

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Problem Statement

Amy Sandberg, a 42-year old female seeks evaluation for 2 episodes of urinary incontinence within the last 24 hours. She denies associated symptoms of dysuria, frequency, hematuria, fevers. She reports a 6 month history of fatigue; 3 month intermittent bilateral and lower-extremity weakness, unreadiness and “pins and needles” and 3 weeks of intermittent blurred vision. She has a PMH of low back “slipped” disk affecting the right leg 10 years prior but resolved. Physical exam finds bilaterally symmetrical upper-and lower-extremity weakness, bilateral, symmetric hyperreflexia throughout. Visual acuity is 20/20 without signs of papilledema.

Management Plan

Patient education regarding multiple sclerosis – unconfirmed
Emphasize follow-up and re-evaluation with new neurologic symptoms
Further baseline immunological testing
Neuro-ophthalmic evaluation
Urogynecologic evaluation
Patient counseling, including recommendations for wellness enhancement e.g. yoga, massage, acupuncture

Reference

McGinley, M. P., Goldschmidt, C. H., & Rae-Grant, A. D. (2021). Diagnosis and treatment of multiple sclerosis: a review. Jama, 325(8), 765-779. https://doi.org/10.1001/jama.2020.26858

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