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Multiple Sclerosis With Initial Stroke-Like Clinicoradiologic Features: Case Report and Literature Review

¹ Departments of Pediatric Neurology and Pediatrics, University of California at Los Angeles Medical Center, California
² Department of Neurology, University of California at Los Angeles Medical Center, and Department of Neurology, Olive View-UCLA Medical Center, California
³ Department of Radiology, University of California at Los Angeles Medical Center, and Department of Radiology, Olive View-UCLA Medical Center, California
⁴ Depts of Neurology and Pediatrics, UCLA Medical Center, and Depts of Neurology and Pediatrics, Olive View-UCLA Medical Center, California

^* To whom correspondence should be addressed. E-mail: mprzeklasa{at}mednet.ucla.edu.

	Abstract

A 17-year-old male presented with sudden onset of persistent focal neurological symptoms. Magnetic resonance imaging (MRI) demonstrated a nonenhancing white matter lesion that appeared hyperintense on fluid-attenuated inversion recovery sequence and diffusion-weighted imaging, while hypointense on apparent diffusion coefficient mapping corresponding to the patient’s clinical features. A smaller subclinical lesion was also present. The patient’s history, radiographic findings, and initial hospital course including response to treatment appeared supportive of a stroke diagnosis. However, a rapid recovery from his severe neurological deficits and results of subsequent serologic testing strongly indicated a demyelinating condition. The onset of adolescent multiple sclerosis can present diagnostic and therapeutic challenges, especially when the initial demyelinating event resembles an acute stroke in clinical and radiographic presentation. Every effort should be made to distinguish these diagnoses as early as possible to ensure timely and appropriate management.

First published on September 30, 2009
Journal of Child Neurology 2009, doi:10.1177/0883073809342490


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