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Clinical presentation of primary progressive multiple sclerosis 10 years after the incidental finding of typical magnetic resonance imaging brain lesions

The subclinical stage of primary progressive multiple sclerosis may last 10 years

Multiple Sclerosis Clinic, Vancouver Hospital & Health Sciences Centre at UBC Hospital, Vancouver, BC, Canada

J Cabrera-Gomez

Multiple Sclerosis Clinic, Vancouver Hospital & Health Sciences Centre at UBC Hospital, Vancouver, BC, Canada

D B Calne

Multiple Sclerosis Clinic, Vancouver Hospital & Health Sciences Centre at UBC Hospital, Vancouver, BC, Canada, Pacific Parkinson Research Group, Vancouver Hospital & Health Sciences Centre at UBC Hospital, Vancouver, BC, Canada

D KB Li

Department of Neuroradiology, Vancouver Hospital & Health Sciences Centre at UBC Hospital, Vancouver, BC, Canada, Brain Research Centre, Vancouver Hospital & Health Sciences Centre at UBC Hospital, Vancouver, BC, Canada

J Oger

Multiple Sclerosis Clinic, Vancouver Hospital & Health Sciences Centre at UBC Hospital, Vancouver, BC, Canada, Brain Research Centre, Vancouver Hospital & Health Sciences Centre at UBC Hospital, Vancouver, BC, Canada, joel.oger{at}ubc.ca

Background: Subclinical multiple sclerosis (MS) has been identified incidentally at autopsy; apparently unaffected individuals with an affected twin have demonstrated magnetic resonance imaging (MRI) changes consistent with MS, and ‘MRI relapses’ are several times more common than clinical relapses. Case description: A 39-year-o ld, right-handed man underwent MRI and PET scanning in 1986 as a ‘normal’ control in a Parkinson’s disease study, where his father was the proband. MRI indicated multiple areas of abnormal signal intensity in a periventricular and grey -white matter junction distribution. Repeated clinical evaluations over the next 10 years were unchanged until 1996, when he complained of progressive weakness of the right foot and clumsiness in the right hand. MRI now indicated a further area of high signal intensity in the right posterior cord at the level of C 5/C 6. There was mild pyramidal distribution weakness in the right leg with an extensor plantar response on the same side. O ver the next five years there has been mild progression in weakness and fatigue and intermittent Lhermitte’s phenomenon. A t no stage has there been a history of relapse, cerebrospinal fluid examination was normal and evoked responses (visual and somatosensory) are normal. Conclusion: This case demonstrates the pheno menon of subclinical MS, unusually supported by prolonged clinical and MRI follow-up. The patient eventually became symptomatic nine years after MRI diagnosis and is following a primary progressive course. A lthough MRI is known to be sensitive in identifying subclinical ‘attacks’, the pattern illustrated here may actually be quite typical of primary progressive MS and is compatible with the later onset seen in this subgroup of patients.

Multiple Sclerosis, Vol. 9, No. 2, 204-209 (2003)
DOI: 10.1191/1352458503ms890cr


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