Breaking Stereotypes: A Unique Presentation of New-Onset Multiple Sclerosis

Abstract

Multiple sclerosis (MS) is a chronic demyelinating disorder resulting in demyelination, neuroaxonal degeneration, and sclerosis. This often-debilitating disease affects young females mainly. Literature describing the pathology and phenotypic features is vast. Although there are extensive descriptions of new-onset MS presentations, few document the initial presentation as a transient ischemic attack or ischemic stroke. The case we present highlights the rarity of such presentation. In the literature, we found scarce reports about MS as presenting as a stroke mimicker with some studies quoting from 2.2% to 4.4% of the cases having MS. Our case serves as a reminder that MS can mimic acute ischemic strokes and the importance of maintaining MS apart of the differential in a young female with no significant history present with acute neurological deficits to reduce the complications of MS and the healthcare-associated costs.

Keywords: acute stroke; atypical presentation; focal neurological deficits; multiple sclerosis; transient ischemic attack.

Figure 1. MRI brain T2 FLAIR showing multiple periventricular demyelinating lesions (black arrows)

FLAIR: fluid-attenuated inversion recovery

Figure 2. MRI brain T2 FLAIR showing multiple sub-cortical demyelinating lesions (black arrows)

FLAIR: fluid-attenuated inversion recovery

Figure 3. MRI brain with contrast showing anterior inferior pontine enhancement (blue arrow)

Figure 4. MRI of cervical spine showing no abnormal enhancement