Case Presentation
A 45-year-old woman was presented with intense itching and tingling on the lower half of the body for a week. The itching resolved suddenly within a few seconds.
Medical History
- The patient had a history of diabetes.
- After recover from flu, the patient complained of difficulty in walking and bilateral prickling sensation in the upper limbs.
- She had multiple admissions in the hospital for recurrent walking abnormalities and numbness and tingling of both hands which resolved after a few days.
- Since 2 years, the patient had intermittent psychiatric symptoms including severe fatigue, aggression and loss of energy.
- The patient had a history of falls following the signs and symptoms.
- No history of trauma, cough or contact with a person with a chronic cough.
- No band like sensation.
- Non-alcoholic and non-smoker.
Clinical Exam
Her physical examination revealed:
- Temperature: 98 °F
- Blood pressure: 110/80 mmHg
- Heart rate: 95 bpm
- Respiratory rate: 19 per minute
- Oxygen saturation: 98% on room air
Her neurological evaluation revealed:
- Spastic quadriparesis with lower limb muscles affected more than the upper limbs
- Reduced general sensations in the lower limbs.
- Numbness and sensory loss in the glove and stocking pattern in the upper extremities.
- No sign of meningeal irritation or cranial nerve deficit.
The psychopathological examination showed:
- Reduced incitement and a slow thought process.
Her MRI revealed:
- Multiple small rounded periventricular plaques in both hemisphere and along with the long axis of the corpus callosum (fluid-attenuated inversion recovery/FLAIR sequence)
- Multiple fresh inflammatory areas after gadolinium enhancement.
- MRI of the spine: Normal.
Laboratory evaluation demonstrated:
- Negative results for hepatitis B virus, human immunodeficiency virus, syphilis, hepatitis C virus, autoimmune antibodies including antinuclear antibody, double-strand DNA antibody, phospholipid antibody, antineutrophil cytoplasmic antibody, perinuclear antineutrophil cytoplasmic antibody, and paraneoplastic syndrome.
- Normal erythrocyte sedimentation rate and C-reactive protein.
- The cerebrospinal fluid was positive for oligoclonal bands.
Diagnosis
The patient was diagnosed with multiple sclerosis.
Treatment
- She was administered methylprednisolone 2 g and carbamazepine.
- The patient experienced gradual resolution of signs and symptoms.
- The patient was discharged on monthly natalizumab.
Follow-Up
- The patient had clinical improvement at follow-up.