title: Spinal segmental myoclonus as an unusual presentation of multiple sclerosis.
abstract: BACKGROUND
  Unusual presentations of multiple sclerosis (MS) at onset may post a diagnostic dilemma to the treating neurologists. Spinal myoclonus is rare in MS and may lead to perform extensive investigations to rule out other etiologies affecting the spinal cord.
  
  
  METHODS
  We described a 31-year-old male who presented with involuntary brief jerky movements of the left shoulder and arm with significant wasting of shoulder muscles. In retrospect, the patient had a progressive right leg weakness one year prior to his presentation. Needle electromyography confirmed the presence of rhythmic irregular burst discharges in motor units of muscles expanding from the third to the sixth cervical region with normal nerve conduction parameters. There was no evidence of cortically generated myoclonic jerks using time-locked electroencephalogram. Magnetic Resonance Imaging of the brain and cervical cord along with the presence of oligoclonal bands in cerebral spinal fluid confirmed the diagnosis of MS. Based on the history and progressive clinical features, a diagnosis of primary progressive MS was established.
  
  
  CONCLUSIONS
  Spinal myoclonus can be the presenting manifestation of MS in association with demyelinating plaques in the root exit zones of the spinal cord. Spinal myoclonus may pose a diagnostic challenge when it presented at the disease onset and especially in patients with progressive course at onset. Our patient represents the first reported primary progressive MS case in the literature with spinal myoclonus presentation.
authors: Department of Medicine, Division of Neurology, Amiri Hospital, Arabian Gulf Street, Sharq, 13041, Kuwait. alroughani@gmail.com.|Department of Medicine, Neurology Clinic, Dasman Diabetes Institute, Kuwait, Kuwait. alroughani@gmail.com.
authors: Raed Abdullah
authors: RA
authors: Alroughani
authors: Department of Neurology, Ibn Sina Hospital, Kuwait, Kuwait. samerelshayb@hotmail.com.|Department of Neurology and Psychiatry, Faculty of medicine, Al-Minia University, Minya, Egypt. samerelshayb@hotmail.com.
authors: Samar Farouk
authors: SF
authors: Ahmed
authors: Department of Neurology, Ibn Sina Hospital, Kuwait, Kuwait. rkhan1948@gmail.com.
authors: Riyadh Ahmed
authors: RA
authors: Khan
authors: Department of Neurology, Ibn Sina Hospital, Kuwait, Kuwait. jasemkumsa@hotmail.com.|Department of Medicine, Kuwait University, Kuwait, Kuwait. jasemkumsa@hotmail.com.
authors: Jasem Yousef
authors: JY
authors: Al-Hashel
mesh_terms: D000328:Adult; D001921:Brain / Q000473:pathology; D004569:Electroencephalography; D004576:Electromyography; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D020528:Multiple Sclerosis, Chronic Progressive / Q000150:complications / Q000175:diagnosis*; D018482:Muscle, Skeletal / Q000473:pathology; D009207:Myoclonus / Q000209:etiology*; D013116:Spinal Cord / Q000473:pathology*