Clinical diagnosis of MS in this patient was made by typical exacerbations and remissions of her illness associated with a great variety of her symptoms. The development of respiratory failure, which is rarely associated with MS, suggests the presence of lesions involving either medullary respiratory center or spinal cord. The lack of bulbar dysfunction, the presence of quadriplegia and the bilateral diaphragmatic weakness in our case strongly indicated the presence of demyelinating lesion in the pyramidal tracts bilaterally. This clinical impression was proved by MRI, which revealed a lesion between CI and C3. In the literature, the presence of the lesions relevant to respiratory failure has been either clinically estimated or proved by the autopsy findings. We emphasize the clinical usefulness of MRI in searching for lesion relevant to the development of respiratory failure in the course of MS.
viagra 50 mg