Case report of possible misdiagnosis of late onset multiple sclerosis with resurfacing of symptoms in her early eighties

Abstract

Background: Late onset multiple sclerosis is relatively unusual and there are limited reports regarding the symptoms, progression and treatment. Case presentation: In this case study, we discuss a patient in her early eighties, with late onset multiple sclerosis presumably misdiagnosed of a transient ischemic attack presenting with numbness of her right hand and face that lasted for three months before they spontaneously regressed remaining dormant for almost 30 years. In 2018, a gradual, but progressive difficulty in walking surfaced. An MRI of the spinal cord was performed in 2019 and described without any pathological findings. On admission in our department, radiological examination revealed multiple lesions in the brain and the spinal cord suggesting a demyelinating condition and corresponded with the MRI of the spinal cord performed in 2019. The cerebrospinal fluid analysis revealed oligoclonal bands suggestive of multiple sclerosis. The patient received a three-day course of high dose prednisolone intravenously. On hospital discharge, the patient reported subjective improvement of the symptoms. Improvement of the symptoms was described by the patient at the 1-month follow-up, though no objective improvement was found on neurological examination. Taking into consideration the age and symptom progression no disease modifying treatment was initiated.