The preliminary diagnosis was cryptogenic stroke with patent foramen ovale (PFO), and the patient was treated with aspirin (100 mg/day) for 7 days, but his episodes persisted. Transcranial Doppler (TCD) contrast agent was used to detect intracardiac shunts, and three microembolic signals were recorded on TCD spectrum by 2 Hz probes within 25 s of contrast injection. The cardiovascular examinations, including extra- and intracranial ultrasound and transthoracic echocardiography, were normal. With the suspicion of TIA, extracranial, intracranial arteries, and the heart were studied.
Description of Laboratory Investigations and Diagnostic TestsĪ head CT excluded intracranial hemorrhage and subarachnoid hemorrhage. There was no history of migraines, and his neurological exam was normal at admission. Cardiovascular risk factors included cigarette smoking of 5–6 cigarettes/day for 10 years. The patient was admitted to our emergency department with the suspicion of TIA. He was completely well between the attacks. He experienced the attacks 20–30 times a day, with each episode lasting 10–20 s. Case Presentation 1Ī 32-year-old male developed episodic, transient, sudden-onset dizziness, left face numbness, and right limb weakness. Both patients were misdiagnosed with TIA before receiving the proper diagnosis of MS. We report two cases of MS with paroxysmal symptoms as their first manifestation and review the literature. Thus, identifying paroxysmal symptoms as a possible first clinical symptom of MS is important for differential diagnosis from TIA, as well as for early diagnosis and treatment of the disease. Paroxysmal symptoms in MS, especially when presented as the first clinical manifestation, could be mistaken for TIA, epilepsy, and neuralgias ( 3). If untreated they tend to continue in clusters for days up to a few months. These transient symptoms are characterized by their brevity, frequency, stereotyped fashion, and response to carbamazepine ( 2). However, paroxysmal symptoms have occasionally been reported in MS since in 1959 ( 1). Based on this pathological feature, the classic clinical manifestations of MS include optic neuritis, long tract symptoms (e.g., numbness or weakness), rather than transient symptoms as in epilepsy and transient ischemic attack (TIA). The characteristic neuropathological feature of MS is the presence of focal demyelinated plaques within white matter of the central nervous system. Multiple sclerosis (MS) is the most common immune-mediated inflammatory demyelinating disease of the central nervous system. Herein, we aim to summarize the differences between paroxysmal symptoms seen in MS and TIA, to facilitate a timely differential diagnosis and recommend an early appropriate treatment. The paroxysmal symptoms responded to carbamazepine and were relieved completely after administration of intravenous methylprednisolone and interferon. Both of the patients’ symptoms were mistaken for TIA at first, based on microembolic signals recorded by transcranial Doppler, but were later correctly diagnosed with MS based on neuroimaging and lumbar puncture. Both cases had paroxysmal symptoms as their first manifestation one presented with transient dizziness, left face numbness, and right limb weakness, and the other presented with episodic lightheadedness, blurred vision, nausea, palpitations, and tremulousness upon standing. Here, we report two additional cases, focusing on the clinical characteristics of paroxysmal symptoms in MS.
Previously, several cases of MS that reported with paroxysmal symptoms were misdiagnosed as TIA.
When presented as the first clinical manifestation, paroxysmal symptoms may easily be mistaken for transient ischemic attack (TIA). Paroxysmal symptoms are unusual manifestations of multiple sclerosis (MS).
0 kommentar(er)
