Document Type : Poster Presentation

Author

• Gholamali Yousefipour

Shiraz University of Medical Science, Shiraz, Iran

Abstract

A 36 year-old-lady, presented with numbness of left side of the face, followed by left-side weakness, upper limb more than the lower, leading to gait difficulty, associated with persistent pain in left knee joint, referred to a neurologist, so work up was done including. Vasculitis and collagen vascular disease lab tests, all were negative. Brain mri was done T2/Flair hyper signal spots were seen in different parts of both cerebral hemispheres, suggestive for nonspecific ischemic insult ,no diffusion restriction, can be suggestive for acute infarction. Neurologic exam.. Patient was alert,orient and cooperative, suffering from LT side weakness and LT side upward plantar reflex,no objective sensory loss in left side. Positive Hx of left eye blurred vision since 8 months ago, fundoscopy was normal.Workup for exclusion of stroke, including lab tests,CDS,and TTE ,were done,which were unremarkable. Again cervical and brain MRIs with &without GD was requested. Brain MRI revealed an indistinct & inhomogeneous region of signal changes in RT hemisphere, cervical mri showed one hypersignal (plaque) at c4-c5 level. Brain MRS was performed which was infavor of atypical form of MS &less possibility a neoplasm, LP was recommended, at first she refused,CSF analysis for OCB and IGg index was done, OCB  with 3 bands was positive, patient,s weakness responded to 5 gr/iv methyl prednisolone in 5 consecutive days. OCT was borderline in both eyes.

Keywords

• MS
• Atypical imaging
• dirthy white matter