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Multiple sclerosis - unpredictable clinical course

Zhenia Hinkova, Dimitrina Yordanova, Kristiana Gocheva, Mihaela Ruseva, Daniela Arabadzhieva


Introduction: Multiple sclerosis (MS) is a chronic autoimmune, inflammatory neurological disease of the central nervous system. MS destroys the myelin of the axons of the brain and spinal cord. It is most common among women aged 15 to 50. A relapsing-remitting type of the disease is preva­lent. Devic`s disease, which was previously considered a variant of MS, causes inflammation of the op­tic nerve and spinal cord.

Materials and methods: This report presents a case of a 37-year-old-woman admitted with complains of weakness of left extremities, vertigo, slurred speech and challenged balance and coordination. Three months prior to the admission, she had double vision in her right eye, when looking to the right, and blurred vision lasting several days. A year before that, she had sensory loss in the left part of the abdomen.

Results: The physical examination revealed lively reflexes of the left extremities, but no abdominal re­flexes on either side. It also showed Romberg - cerebellar, Babinski sign - on the left foot, intention­al tremor on the left side and segmented hypoesthesia. The conducted magnetic resonance imaging confirmed a demyelinating process. Specialized examinations such as the Expanded Disability Status Scale revealed 3, sensory evoked potentials showed increased latent time for 3-5 waves on both sides. Upon consulting a neuro-ophtаlmologist a pale temporal excavation of the right papilla and a pale left papilla were revealed. Differential diagnosis with Devic`s disease was made, but due to all of the examinations, the patient was diagnosed with a relapsing-remitting form of MS.

Conclusion: MS takes unpredictable clinical courses. An uncommon start can be presented as De­vic`s disease. The disruption of the myelin leads to irreversible neurological damage, but the symp­toms can be treated.


multiple sclerosis; demyelinating process; relapsing-remitting form; Devic`s disease



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