Case-report: Scleroderma with longitudinally extensive myelitis

Abstract

WCN 2013 No: 2685 Topic: 6 — MS & Demyelinating Diseases Case-report: Scleroderma with longitudinally extensive myelitis J.P.R.P.T. de Azevedo, G.D.C. Ferreira, F.K.M.S. Pinto, L.A.A. Reis, L.V. de Oliveira, D.S. Diniz. Neuroscience Nucleus, Clinical Hospital of Goias Federal University, Goiânia, Brazil; Faculty of Medicine, Federal University of Goias, Goiania, Brazil Background: There is an intrinsic relationship between systemic autoimmune diseases and myelitis. Most of them are reported with acute transverse myelitis, some of them with longitudinally extensive myelitis (LTEM) and by now in the Neuromyelitis optica spectrum disorders (NOSD) Researching in major scientific directories there are no cases reporting the association between acute myelitis and Scleroderma. Objective: Describe an unreported association with Scleroderma and LTEM. Patients and methods: A 53 year old man was admitted with progressive weakness in the last 24 h. Symptoms began with sudden pain and leg paresthesia and evolved to a complete medullary syndrome with paraplegia, bladder dysfunction and a sensory impairment by the level of T8. He was previously diagnosed with Scleroderma four years ago. He presented by Raynoud fenomena, sclerodactyly and telangiectasia in the face, chest, and upper and lower limbs. He presented a positive nucleolar pattern ANA. Lab tests have shown elevated proteins in CSF and elevated CRP and ESR. A full spinal MRI has shown a contiguous T2 increased signal beginning from the bottom of the medulla oblongata to the level of T8 confirmed in the transactional view. Results: The patient was submitted to a five-day course of Methylprednisolone followed by a course of Intravenous Human Hyperimmune Gammaglobulin. The patientwas dischargedwith prednisone, colchicin and chloroquine. He returned 27 days later fully walking, without bladder or sensory dysfunctions. Antiaquaporin-4 IgG autoantibody was negative. Conclusion: This case reported the association between Scleroderma and LTEM in the NOSD. doi:10.1016/j.jns.2013.07.1348 Abstract — WCN 2013 No: 2707 Topic: 6 — MS & Demyelinating Diseases Neurological symptoms in demyelinating disease mimicking an acute ischaemic stroke—Case report WCN 2013 No: 2707 Topic: 6 — MS & Demyelinating Diseases Neurological symptoms in demyelinating disease mimicking an acute ischaemic stroke—Case report K. Majstorovic, A. Arsovska, M. Perovska. Institute of Nephrology, Struga, The Former Yugoslav Republic of Macedonia; University Clinic of Neurology, Skopje, The Former Yugoslav Republic of Macedonia Background: The case presented here emphasizes the role of an accurate diagnosis for proper targeting of therapy. Objective: Demyelinating disease should be considered even in older patients with focal and fluctuating neurological symptoms. Patients and methods: In March 2013, a 50-year-old woman was admitted with acute left hemiplegia and severe dysarthria, which occurred three days ago. Ten days earlier the patient had intense vertigo, nausea, vomiting, diplopiae, speech difficulty and unstable gait. Neurological status on admission showed severe dysarthria, bilateral rhythmic nystagmus, left hemiplegia, vivid generalized muscle tendon reflexes with asymmetry in the right and positive Babinski sign on the right. In the following days MRI of the brain and lumbal puncture were performed. MRI of the brain showed hypersignal changes in T2 and FLAIR images. CSF electrophoresis showed mild immune activity in the central nervous system.VEP showed a prolonged latency in P100 on the right eye. Results: Therefore, disseminated demyelinating process was diagnosed and intravenous methylprednisolone treatment was initiated (1 g/day for 5 days) with a subsequent progressive improvement of the neurological symptoms. Discussion: Our case has shown that sudden, rapid and unusual neurological deficits can be observed in multiple sclerosis (MS). In such cases, there is a wide range of diseases in the differential diagnosis, including ischemic cerebrovascular events. The presented case demonstrates rare Multiple Sclerosis cases with late onset of the disease by the age of 50.The correct diagnosis of these two entities is essential for proper treatment. doi:10.1016/j.jns.2013.07.1349 Abstract — WCN 2013 No: 2349 Topic: 6 — MS & Demyelinating Diseases Memory impairment in patients with clinically isolated syndrome WCN 2013 No: 2349 Topic: 6 — MS & Demyelinating Diseases Memory impairment in patients with clinically isolated syndrome E.Hyncicova, E.Meluzinova,M. Vyhnalek, J. Vecanova, J. Libertinova, I. Kovařova, T. Nikolai, J. Hort, J. Laczo. Department of Neurology, 2nd Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic; International Clinical Research Center, St. Anne's University Hospital Brno, Brno, Czech Republic; Department of Neurology, 1st Faculty ofMedicine, Charles University andGeneral UniversityHospital in Prague, Prague, Czech Republic Abstracts / Journal of the Neurological Sciences 333 (2013) e358–e421 e369