Multiple sclerosis with initial stroke-like clinicoradiologic features: case report and literature review.
A 17-year-old male presented with sudden onset of persistent focal neurological symptoms. Magnetic resonance imaging (MRI) demonstrated a nonenhancing white matter lesion that appeared hyperintense on fluid-attenuated inversion recovery sequence and diffusion-weighted imaging, while hypointense on apparent diffusion coefficient mapping corresponding to the patient's clinical features. A smaller subclinical lesion was also present. The patient's history, radiographic findings, and initial hospital course including response to treatment appeared supportive of a stroke diagnosis. However, a rapid recovery from his severe neurological deficits and results of subsequent serologic testing strongly indicated a demyelinating condition. The onset of adolescent multiple sclerosis can present diagnostic and therapeutic challenges, especially when the initial demyelinating event resembles an acute stroke in clinical and radiographic presentation. Every effort should be made to distinguish these diagnoses as early as possible to ensure timely and appropriate management.
Department of Pediatric Neurology, University of California at Los Angeles Medical Center, California 90095, USA. mprzeklasa@mednet.ucla.edu
Melissa
M
Przeklasa-Auth
Bruce
B
Ovbiagele
Catherine
C
Yim
D Alan
DA
Shewmon
D000293:Adolescent; D001921:Brain / Q000473:pathology*; D002545:Brain Ischemia / Q000175:diagnosis*; D001931:Brain Mapping; D003937:Diagnosis, Differential; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008279:Magnetic Resonance Imaging; D008297:Male; D009103:Multiple Sclerosis / Q000175:diagnosis*; D009413:Nerve Fibers, Myelinated / Q000473:pathology; D009460:Neurologic Examination; D020521:Stroke / Q000175:diagnosis*