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Vol 5, No 2 (2003)
Prace kazuistyczne
Published online: 2003-08-04
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Stroke-like course of multiple sclerosis with the very late onset

Beata Żyluk, Teresa Korwin-Piotrowska
Udar Mózgu. Problemy Interdyscyplinarne 2003;5(2):37-40.

open access

Vol 5, No 2 (2003)
Prace kazuistyczne
Published online: 2003-08-04

Abstract

Multiple sclerosis (MS) is a demyelinating disease of the central nervous system mostly affecting young alults. Well-accepted diagnostic criteria suggest 59 years as the upper limit of age at onset. For this reason a diagnosis of MS in older individuals is frequently not taken into consideration. Nevertheless, the initial symptoms of the disease may appear, though rarely, after the age of 60, 70 or even 80 years.
We present a case history of a patient with a very late onset of MS. A previously healthy, 63-year-old man was addmitted to the hospital due to sudden weakness of his right limbs. A detailed interview has not revealed any kind of neurologic dysfunction before the actual attack. Central paresis of the face muscles, and slight spastic weakness of the right limbs suggested the left hemisphere localization of the lesion. Taking into consideration the advanced age of a patient, the initial diagnosis of stroke was established. Computed tomography scan revealed a hypodense lesion near the frontal cornu of the left lateral ventricle of probable ischaemic origin. During a few days of hospitalization a neurological condition of a patient got worse. The right limbs paresis intensified into paralysis and deep sensation deficits in the left limbs appeared. Magnetic resonance imaging showed many periventricular lesions within the white matter of both hemispheres, which were hyperintense on T2-weighted images. According to these observations a diagnosis of stroke had to be changed into MS. Due to the treatment with intravenous steroids an appreciable improvement of patient’s condition was reached.
Diagnostic difficulties described in our case report were associated with the following conditions: 1) a very late onset and untypical course of the disease (the clincal course of MS in patients after 60 years at onset tends to be slowly progressive from the beginning rather than relapsing - remitting); 2) site of clinical involvement (in MS of late onset predominant involvement affects spinal cord. Cerebral involvement with acute motor funcion deterioration is extremely rare).
Our case report shows that MS should not be considered as diagnosis of exclusion in patients after age 60. Moreover, the course of MS may imitate stroke, much more common at this period of life.

Abstract

Multiple sclerosis (MS) is a demyelinating disease of the central nervous system mostly affecting young alults. Well-accepted diagnostic criteria suggest 59 years as the upper limit of age at onset. For this reason a diagnosis of MS in older individuals is frequently not taken into consideration. Nevertheless, the initial symptoms of the disease may appear, though rarely, after the age of 60, 70 or even 80 years.
We present a case history of a patient with a very late onset of MS. A previously healthy, 63-year-old man was addmitted to the hospital due to sudden weakness of his right limbs. A detailed interview has not revealed any kind of neurologic dysfunction before the actual attack. Central paresis of the face muscles, and slight spastic weakness of the right limbs suggested the left hemisphere localization of the lesion. Taking into consideration the advanced age of a patient, the initial diagnosis of stroke was established. Computed tomography scan revealed a hypodense lesion near the frontal cornu of the left lateral ventricle of probable ischaemic origin. During a few days of hospitalization a neurological condition of a patient got worse. The right limbs paresis intensified into paralysis and deep sensation deficits in the left limbs appeared. Magnetic resonance imaging showed many periventricular lesions within the white matter of both hemispheres, which were hyperintense on T2-weighted images. According to these observations a diagnosis of stroke had to be changed into MS. Due to the treatment with intravenous steroids an appreciable improvement of patient’s condition was reached.
Diagnostic difficulties described in our case report were associated with the following conditions: 1) a very late onset and untypical course of the disease (the clincal course of MS in patients after 60 years at onset tends to be slowly progressive from the beginning rather than relapsing - remitting); 2) site of clinical involvement (in MS of late onset predominant involvement affects spinal cord. Cerebral involvement with acute motor funcion deterioration is extremely rare).
Our case report shows that MS should not be considered as diagnosis of exclusion in patients after age 60. Moreover, the course of MS may imitate stroke, much more common at this period of life.
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Keywords

multiple sclerosis; late onset; stroke-like course

About this article
Title

Stroke-like course of multiple sclerosis with the very late onset

Journal

Interdisciplinary Problems of Stroke

Issue

Vol 5, No 2 (2003)

Pages

37-40

Published online

2003-08-04

Bibliographic record

Udar Mózgu. Problemy Interdyscyplinarne 2003;5(2):37-40.

Keywords

multiple sclerosis
late onset
stroke-like course

Authors

Beata Żyluk
Teresa Korwin-Piotrowska

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