Multiple sclerosis following a spinal cord injury: a rare and unfortunate case

Abstract

This is a case report and review of literature with the objective report of the case of a young man with physical disability following a traumatic spinal cord injury (SCI) who was later newly diagnosed with multiple sclerosis (MS) in an inpatient SCI rehabilitation center. (Barcelona, Spain). A 24-year-old male sustained a traumatic spinal cord lesion (T9 AIS A) as the result of a motorcycle accident. He completed his rehabilitation process without complications and returned to the community having adjusted to his new disability. Two and a half years after his initial injury, he attended the clinic after experiencing 2 months of paresthesias in his left hand, progressing to his right upper limb, and difficulty with fine hand movements. An magnetic resonance imaging (MRI) was arranged and although post-traumatic syringomyelia was ruled out, demyelinating areas in the cervical spinal cord were found. A brain MRI revealed multiple demyelinating lesions suggestive of MS. The diagnosis of MS was confirmed by a neurologist and treatment was started with daily doses of glatiramer acetate. At this time the patient was still independent in transfers, activities of daily living and wheelchair management. In young patients with SCI, adequate follow-up is important to detect subsequent complications that may lead to clinical and functional deterioration with a view to uncommon causes such as MS.

Keywords: Multiple sclerosis; Neurological manifestations; Spinal cord diseases.

Figure 1

Sagittal T2-weighted MRI of the spine showing spinal cord lesion due to a T8–T9 fracture-luxation.

Figure 2

Sagittal T2-weighted cervical MRI showing three demyelinating focus between C1 and C6.

Figure 3

Axial T2-flair-weighted brain MRI showing multiple demyelinating lesions suggestive of MS.