Normal conduction in pathways traversing an asymptomatic multiple sclerosis plaque.
A 31-year-old woman developed right facial myokymia as the initial manifestation of multiple sclerosis (MS). An MRI scan revealed a focal signal abnormality confined to the left dorsolateral pontomedullary region. Brain-stem auditory evoked potentials (BAEPs), somatosensory evoked potentials (SEPs), and blink reflex (BR) failed to show a conduction abnormality through the left brain-stem lesion. Instead, BAEP and BR indicated a conduction defect in the right pons and EMG showed myokymic discharges in right facial muscles. Our findings provide rare documentation of normal conduction through a presumably asymptomatic MS plaque. The abnormal MRI signal likely represents tissue edema, rather than demyelination. This case demonstrates that physical findings in MS patients may correlate better with electrophysiological abnormalities than with MRI abnormalities.
Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City 52242.
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Ross
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Leis
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Krain
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Mitchell
D000328:Adult; D001767:Blinking / Q000502:physiology; D004576:Electromyography; D016057:Evoked Potentials, Auditory, Brain Stem / Q000502:physiology*; D005207:Fasciculation / Q000209:etiology / Q000503:physiopathology; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D009103:Multiple Sclerosis / Q000150:complications / Q000473:pathology / Q000503:physiopathology*; D009431:Neural Conduction / Q000502:physiology*; D011930:Reaction Time