Working Diagnosis:
Multiple Sclerosis with resultant severe muscle spasms

Treatment:
She was treated with Tegretol and valium for muscle spasms. She also underwent an extensive physical therapy program. She was dismissed from the hospital to an inpatient rehab facility, where she stayed for four weeks.

Outcome:
After three months of her extensive rehab program, the patient was able to walk again. Her pain dramatically decreased two days after starting her antispasmodic medications. She continues to do well two years after her diagnosis.

Author's Comments:
Multiple Sclerosis (MS) is an inflammatory demyelinating disease of the central nervous system (CNS). It most commonly affects women in their twenties and thirties. Clinical manifestations are the results of inflammation, axon degeneration and demyelination. Clinical features are highly variable and can include visual complaints, Lhermitte sign, fatigue as eel as gait disturbances in addition to many other non specific symptoms. Diagnosis is often delayed due to the non specific presentations. Diagnosis includes at least two distinct CNS events with partial resolution. Laboratory tests that support the diagnosis include visual evokes response, CSF fluid oligoclonal banding and IgG as well as classic findings on brain MRI. McDonald criteria was developed in 2001 and revised in 2010 using neuro imaging to support the diagnosis of MS. These criteria include dissemination in space of T2 lesion in class MS locations (periventricular, juxtacortical, infratentorial or spinal cord) and dissemination in time with different appearing or new lesions noted on MRI.

In this case we report and atypical presentation for the initial diagnosis of multiple sclerosis.

When myelomalacia of the spinal cord is found, it should raise suspicion for multiple sclerosis.

Muscle spasms can be a significant cause of morbidity for patients with MS.

Return To The Case Studies List.