Atypical clinical and radiological presentation of multiple sclerosis: A case report

Abstract

A 59-year-old, previously healthy Caucasian female patient presented to the ED with a sudden onset of focal neurological deficit, with stable vital signs. Her initial physical examination revealed left-sided facial nerve palsy and right lower extremity weakness. The CT head was negative for intracranial bleeding. Subsequently, during her hospital stay, the MRI brain with contrast demonstrated extensive white matter cystic lesions with vasogenic edema. However, after carefully ruling out stroke, metastatic disease, and infectious diseases like neurocysticercosis with radiological and serological tests, the diagnosis of demyelinating condition was presumed, and it was proven by consequent MRI of the brain and elevated IgG levels in the CSF. The patient's initial clinical presentation was pointing towards the diagnosis of ischemic stroke, while her initial MRI brain suggested the diagnosis of the space-occupying lesions, however, rapid recovery of the focal neurological deficit with steroids, and subsequent MRI brain and spine, and CSF tests confirmed the diagnosis of a demyelinating condition. The objective of this case report is to inform physicians that the clinical and radiological presentation of multiple sclerosis can be challenging; therefore, physicians should keep a high index of suspicion.