Case Presentation
A 33-year-old man was presented with progressive inability to speak since past 2 days.
Medical History
- The patient was a known hypertensive; noncompliant to medication.
- No recent episodes of headache, nausea, balance problems, falls or weakness.
- Since past 2 years, he was visiting his ophthalmologist for blurry vision of left eye and used contact lens.
Clinical Exam
His physical examination revealed:
- Blood pressure: 189/137 mm Hg
- Muscle strength of 5/5 in all four extremities
- Intact sensations
- Normal deep tendon reflexes
- No appreciable nystagmus
Speech evaluation showed:
- Significant anomia
- Word-finding difficulty
- Non-fluency in speech
- Appropriate comprehension
- Slightly reduced attention-requiring occasional repetition of prompts
- Obvious limitation of expressive language skills
- Inability to answer with “YES” or “NO” within few hours of presentation
CT scan of the head and CT angiography of the head and neck: Unremarkable
MRI Spine: Negative for any demyelinating plaques
MRI of brain with contrast found:
- Patchy areas of T2 hyperintense signal within the central aspect of pons and throughout the supratentorial white matter in a periventricular and subcortical distribution
- Mild T2 hyperintense signal along the undersurface of the corpus callosum
Diagnosis
The patient was diagnosed with multiple sclerosis based on revised McDonald’s criteria.
Preliminary Treatment
- The patient received nicardipine drip for targeted blood pressure goal, along with aspirin and atorvastatin for prevention of possible hypertensive emergency/cerebrovascular accident.
Preliminary Treatment
- He was initiated on methylprednisolone 1 g IV infusion daily for five days.
- Physical, occupational and speech therapies were started.
Post-Treatment Outcomes
- Over four days, his symptoms improved significantly.
- The patient was able to articulate without difficulty.
- The word-finding pauses slowly disappeared.
- The patient was discharged on day 5.