Unusual primary manifestations of multiple sclerosis: A case report

Abstract

Isolated cranial nerve involvement is rarely seen in multiple sclerosis patients. A 17-year-old female patient presented with complaints of numbness in the right half of her face, difficulty in chewing with the right jaw, having the right corner of her mouth drooping to the right, and blurring in both eyes. She had loss of sensation, left central facial paralysis, and frust monoparesis in the left arm in the right trigeminal nerve dermatome. Following systemic steroid treatment, her left central facial paralysis and chewing difficulties regressed, and loss of sensation improved. As in this case, MS may present with multiple instances of cranial nerve paralysis in addition to the involvement in the extremities. The association of the fifth and seventh nerve palsy in MS is rarely seen in the literature.

Keywords

• Multiple sclerosis
• Facial paralysis
• Cranial nerve neuropathy

References

1. 1. Köseoğlu M, Çelik RGG, Tütüncü M, Bingöl A, Erbaş B, Deringöl D, et al. Sexual dysfunction and associated risk factors in multiple sclerosis. J Surg Med. 2020;4(9):779-83.
2. 2. Park KA, Oh SY, Min JH, Kim BJ, Kim Y. Cause of acquired onset of diplopia due to isolated third, fourth, and sixth cranial nerve palsies in patients aged 20 to 50 years in Korea: A high resolution magnetic resonance imaging study. J Neurol Sci. 2019 Dec 15;407:116546. doi: 10.1016/j.jns.2019.
3. 3. Commins DJ, Chen JM. Multiple sclerosis: a consideration in acute cranial nerve palsies. Am J Otol 1997 Sep;18(5):590-5. PMID: 9303155.
4. 4. Ratnayake EC, Caldera M, Perera P, Gamage R. Isolated trigeminal nerve palsy with motor involvement as a presenting manifestation of multiple sclerosis in an equatorial region-a case report. Int Arch Med. 2012 May 30;5(1):17. doi: 10.1186/1755-7682-5-17. PMID: 22647398; PMCID: PMC3403846.
5. 5. Kwon JY, Kim JY, Jeong JH, Park KD. Multiple sclerosis and peripheral multifocal demyelinating neuropathies occurring in a same patient. J Clin Neurol. 2008 Mar;4(1):51-7. doi: 10.3988/jcn.2008.4.1.51.
6. 6. Fukazawa T, Moriwaka F, Hamada K, Hamada T, Tashiro K. Facial palsy in multiple sclerosis. J Neurol. 1997 Oct;244(10):631-3. doi: 10.1007/s004150050158.
7. 7. Critchley EP. Multiple sclerosis initially presenting as facial palsy. Aviat Space Environ Med. 2004 Nov;75(11):1001-4. PMID: 15559004.
8. 8. Zadro I, Barun B, Habek M, Brinar VV. Isolated cranial nerve palsies in multiple sclerosis. Clin Neurol Neurosurg. 2008 Nov;110(9):886-8. doi: 10.1016/j.clineuro.2008.02.009.

9. 9. Sorgun MH, Kocer B, Kaplan F, Yılmaz N, Yücemen N, Yücesan C. Cranial Neuropathy in Multiple Sclerosis Turk J Neurol. 2011;17:137-42.
10. 10. Ebers GC, Sadovnick AD: The geographic distribution of multiple sclerosis: a review. Neuroepidemiology. 1993;12(1):1-5. doi: 10.1159/000110293.
11. 11. Kahana E, Leibowitz U, Alter M. Brainstem and cranial nerve involvement in multiple sclerosis. Acta Neurol Scand. 1973;49(3):269-79. doi: 10.1111/j.1600-0404.1973.tb01299.x.
12. 12. Thömke F, Lensch E, Ringel K, Hopf HC. Isolated cranial nerve palsies in multiple sclerosis. J Neurol Neurosurg Psychiatry 1997; 63: 682-85.
13. 13. Hooge JP, Redekop WK. Trigeminal neuralgia in multiple sclerosis. Neurology. 1995 Jul;45(7):1294-6. doi: 10.1212/wnl.45.7.1294.
14. 14. Gass A, Kitchen N, MacManus DG, Moseley IF, Hennerici MG, Miller DH. Trigeminal neuralgia in patients with multiple sclerosis: lesion localization with magnetic resonance imaging. Neurology. 1997 Oct;49(4):1142-4. doi: 10.1212/wnl.49.4.1142.
15. 15. Yetimalar Y, Secil Y, Inceoglu AK, Eren S, Basoglu M. Unusual primary manifestations of multiple sclerosis. N Z Med J. 2008 Jul 4;121(1277):47-59. PMID: 18677330.