Presenting Sign Of Multiple Sclerosis Research Articles

Blepharospasm and Sixth Nerve Palsy as the Presenting Sign of Multiple Sclerosis.

Blepharospasm and Sixth Nerve Palsy as the Presenting Sign of Multiple Sclerosis.

Bilateral Pupil-Sparing Third Nerve Palsies as the Presenting Sign of Multiple Sclerosis

We report the case of a young man who presented with bilateral third nerve palsies without pupillary involvement. Brain MRI demonstrated lesions in the region of the oculomotor nerves, and further evaluation led to the diagnosis of multiple sclerosis. Our case documents a rare initial clinical presentation of this demyelinating disease.

Isolated oculomotor nerve paresis as the presenting sign of multiple sclerosis

In multiple sclerosis (MS), ocular motor disturbances such as nystagmus or internuclear ophthalmoplegia are frequent and their pathophysiological processes are relatively well known. On the contrary, other rare and not so well studied manifestations such as isolated ocular motor nerve palsy may be observed and can represent a diagnostic challenge for the clinician as in the case we report. case

Bilateral Internuclear Ophthalmoplegia as a Presenting Sign of Multiple Sclerosis: An Interdisciplinary Approach to Diagnosis and Management

Bilateral Internuclear Ophthalmoplegia as a Presenting Sign of Multiple Sclerosis: An Interdisciplinary Approach to Diagnosis and Management

Neuritis nervi optici nach dem 50. Lebensjahr: Symptom einer bislang nicht diagnostizierten multiplen Sklerose

The onset of multiple sclerosis after the age of 50 years is rare. We report four patients with optic neuritis and oligoclonal bands or increased IgG production in the cerebrospinal fluid. Three of them subsequently developed clinically definite multiple sclerosis. Four apparently healthy women, 62, 56, 50 and 50 years of age, presented with progressive visual loss, three patients in one eye and one patient in both eyes. The diagnostic work-up revealed no findings indicating an ischemic process, an infectious, systemic inflammatory, or neoplastic disease. Examination of the cerebrospinal fluid revealed oligoclonal bands and/or increased production of IgG. Visual acuity recovered during the following weeks to 8 months. Three of the 4 patients subsequently developed additional neurologic signs compatible with multiple sclerosis. Optic neuritis can be the presenting sign of multiple sclerosis even after the age of 50.

Hemiparesis and homonymous hemianopia as the presenting sign of multiple sclerosis

We report two young patients presenting with acute homonymous hemianopia and acute severe hemiparesis involving the face. The diagnostic work-up led to the diagnosis of multiple sclerosis.Clinically symptomatic retrochiasmal demyelinating lesions are rare even in the long-term course of multiple sclerosis and those affecting the pyramidal tract usually produce only mild partial dysfunction with bilateral symptoms due to brainstem or spinal cord involvement. Acute homonymous hemianopia or motor hemiparesis first suggest another etiology than multiple sclerosis, particularly a vascular lesion. MRI is the investigation of choice in this clinical setting, showing an unusually large lesion in most cases where a demyelination is the cause. Clinical recovery nevertheless is usually excellent, despite persistence of the lesion on repeated imaging. This contrasts with that of an infarction and also with that of acute monophasic demyelinating disease (Marburg, Balo), variants of multiple sclerosis that need to be considered initially.

Isolated sixth-nerve palsy as the presenting sign of multiple sclerosis

The author reports a young patient presenting isolated (fascicular) abducens nerve palsy as the only and first sign of multiple sclerosis. Whereas diplopia-a common symptom of multiple sclerosis-is usually due to supranuclear brainstem dysfunction, it is rarely caused by sixth-nerve palsy. In larger series analysing the aetiologies of sixth-nerve palsies, multiple sclerosis was a rare cause, particularly in the case of isolated sixth-nerve palsy. However, these studies were done decades ago when adequate imaging procedures were not available. Nowadays, the large group with undetermined cause should shrink when appropriate diagnostic work-up such as application of MRI is performed. This case demonstrates that demyelinating brainstem lesions with appropriate location in the course of the sixth-nerve fascicle may cause isolated sixth-nerve palsy.

Isolated Pupil-Sparing Third-Nerve Palsy as the Presenting Sign of Multiple Sclerosis

A 27-year-old man presented with an isolated, pupil-sparing, partial third-nerve palsy. Etiologic investigations proved unrevealing. Subsequent development of an optic neuropathy prompted magnetic resonance imaging, which confirmed the clinical suspicion of multiple sclerosis. Rarely does multiple sclerosis present with oculomotor nerve involvement.