A Case Report on Multiple Sclerosis Associated With Atrial Fibrillation and Neurogenic Hypertension: Area Postrema Syndrome?

Abstract

Multiple sclerosis (MS) is an autoimmune demyelinating neurological disorder primarily manifesting with a range of neurological symptoms, with cardiovascular autonomic involvement being a rare occurrence. We report a case where a patient initially presented with Bell's palsy, without other notable symptoms or signs, and subsequently developed atrial fibrillation, hypertension, and hemiparesis. Magnetic resonance imaging (MRI) revealed extensive demyelination in the cerebral hemispheres, brainstem, and notably, the area postrema. The anatomy of the area postrema and its connections, in relation to neurogenic hypertension, are discussed. The demyelination in the area postrema was thought to be the cause of our patient's arrhythmias and acute hypertension. Furthermore, we discuss the cerebral origins of cardiac arrhythmias, with a focus on MS and other neurological conditions. This case underscores the rarity of isolated cranial neuropathies, such as Bell's palsy, as an initial sign of MS, marking the onset of a relapse.

Keywords: area postrema (ap); atrial fibrillation; bell's palsy; multiple sclerosis; neurogenic hypertension.

Figure 1. T1 sagittal MRI arrow showing an area of demyelination adjacent to the corpus callosum

Figure 2. 1T MRI axial Image showing an area of demyelination in the right medulla on the floor of the fourth ventricle (white arrow)

Figure 3. 1T axial MRI T2-weighted image showing enhancement of area postrema bilaterally (blue arrows)