How is MS diagnosed in elderly patients with complex symptoms?

Hello doctor,

My 66-year-old father, who is a retired schoolteacher, had a cold and a cough for 10 days. A month back, he developed slurred speech, blurred vision, double vision, giddiness, imbalance, nasal intonation of voice, and hypertension. Blood pressure was fluctuating.

As per him, symptoms were worse in the morning and improved gradually as the day passed by. There was no headache, vomiting, seizure, loss of control, or bowel or bladder incontinence. Computed tomography (CT) of the brain, done at first, was reported as a left external capsular infarct.

A magnetic resonance imaging (MRI) done revealed a prominent right cavernous sinus to correlate with significance; there is age-related cerebral atrophy with white matter changes.

Doctors first doubted MG, then MS. The neostigmine test came back negative.

He was started on,

• An antibiotic.
• A course of IV Methylprednisolone.
• A lipid-lowering agent.
• A PPI and supportive care.
• Blood parameters showed a raised total count (TC).
• Renal function test (RFT).
• Uric acid.
• Serum glutamic oxalate transaminase (SGOT).
• Serum glutamic pyruvic transaminase (SGPT).
• Cerebrospinal fluid (CSF) analysis showed raised protein and total count (TC).

With treatment, a bit of improvement was seen, but not substantial. Ten years ago, he was diagnosed with retrobulbar neuritis. Doctors are more or less supposing it to be MS and gave a further course of prednisolone of 20 mg and Atorvastatin 20 mg tablets along with those for hypertension, cough, and acidity and advised taking care of the blood pressure.

There are no definitive answers or assurances. What should we do?

Please help.