["Numb chin syndrome": first presenting syndrome of multiple sclerosis?].
METHODS
A 34-year-old previously healthy woman presented with a five-day history of subacute onset of a numb chin. Examination on admission revealed isolated hypesthesia on the left side of the chin and lower lip.


METHODS
Brain magnetic resonance imaging (MRI) demonstrated a lesion involving the pontine trigeminal fibers and multiple periventricular T2-hyperintense white matter lesions suggestive of inflammatory /demyelinating disease. Cerebrospinal fluid analysis revealed oligoclonal IgG bands (only in cerebrospinal fluid) and an increased IgG index. A follow-up MRI after four months demonstrated new supratentorial brain lesions, confirming a syndrome, highly suggestive of multiple sclerosis as the likely underlying diagnosis. TREATMENT AND FOLLOW-UP: The facial sensory disturbance resolved spontaneously. Prophylactic treatment with interferon-beta was started.


CONCLUSIONS
The numb chin syndrome may be the initial presentation of a clinically isolated syndrome suggestive of multiple sclerosis. Prophylactic immunomodulatory treatment may be started after the suspicion of inflammatory/demyelinating activity is confirmed.
Oestmann
A
A
Medizinische Klinik, Universitätsspital Basel. Andreas.Oestmann@insel.ch
Achtnichts
L
L
Kappos
L
L
Gass
A
A
Naegelin
Y
Y
D000328:Adult; D001921:Brain / Q000473:pathology; D002680:Chin; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D006987:Hypesthesia / Q000175:diagnosis / Q000209:etiology*; D007074:Immunoglobulin G / Q000134:cerebrospinal fluid; D007155:Immunologic Factors / Q000627:therapeutic use; D016899:Interferon-beta / Q000627:therapeutic use; D008046:Lip; D008279:Magnetic Resonance Imaging; D009103:Multiple Sclerosis / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy; D013577:Syndrome; D014276:Trigeminal Nerve / Q000473:pathology
D007074:Immunoglobulin G; D007155:Immunologic Factors; D016899:Interferon-beta