Acute Ischemic Stroke in a Patient with Multiple Sclerosis Presenting with Left Hemiplegia and Dysarthria

Abstract

Endothelial dysfunction induced by chronic inflammation in the central nervous system and associated atherosclerosis increases the risk of cerebrovascular disease in Multiple Sclerosis. A 54 years-old woman with multiple sclerosis (secondary progressive), hypertension (regular) and EDSS score 6 was brought with sudden loss of power on her left side as well as speech and swallowing disturbances after high dose intravenous pulse steroid therapy. Acute infarcts with diffusion restriction were observed in mesencephalon, cerebellar hemispheres and right side of pons in diffusion MR which was requested in the emergency department. Carotid-vertebral Doppler ultrasonography and transthoracic echocardiography performed to investigate etiology of stroke were normal. Arrhythmia was not observed in rhythm Holter evaluation. Routine laboratory tests, thrombosis and vasculitis markers were found to be normal. Multiple Sclerosis and immobility were considered as the cause of stroke for this patient. The possibility of stroke and a non-attack pathology should always be kept in mind when Multiple Sclerosis patients admit with a new onset neurological dysfunction.

Keywords

• Multiple Sclerosis,ischemic stroke,atherosclerosis

SOL HEMİPLEJİ VE DİZARTRİ İLE BAŞVURAN MULTİPL SKLEROZ TANILI HASTADA AKUT İSKEMİK İNME

Abstract

Multipl Sklerozda, santral sinir sistemindeki kronik inflamasyonun indüklediği endotelial disfonksiyon ve buna bağlı ateroskleroz serebrovasküler hastalık riskini artırır. Multipl Skleroz (sekonder progressif) ve hipertansiyon (regüle) tanıları olup EDSS skoru 6 olan 54 yaşındaki bayan hasta intravenöz yüksek doz pulse steroid tedavisi sonrası sol tarafında ani güç kaybı, konuşma ve yutma bozukluğu ile getirildi. Acil servisteki difüzyon MR’da mezensefalon ile pons sağ kesiminde, serebellar hemisferlerde difüzyon kısıtlaması gösteren akut enfarkt alanları izlendi. İnme etiyolojisine yönelik yapılan karotis-vertebral doopler ultrasonografi ve transtorasik ekokardiografi normaldi. Ritm holterde, aritmi izlenmedi. Rutin laboratuar tetkikleri, tromboz ve vaskülit markerlerinde patoloji saptanmadı. Olguda inme nedeni olarak Multipl Skleroz ve immobilite düşünüldü.

Multipl Skleroz hastalarında yeni gelişen nörolojik disfonksiyon durumunda atak dışı neden, inme olasılığı da her zaman akılda tutulmalıdır.

Keywords

• Multipl Skleroz,iskemik inme,ateroskleroz

References

1. Kutzelnigg A, Lassmann H. Pathology of multiple sclerosis and related inflammatory demyelinating diseases. In: Goodin DS, eds. Handbook of Clinical Neurology. 3rd ed. China: Elsevier B.V. 2014:15-58.
2. Werner P, Pitt D, Raine CS. Multiple sclerosis: altered glutamate homeostasis in lesions correlates with oligodendrocyte and axonal damage. Ann Neurol. 2001;50(2):169-80.
3. Van Horssen J, Witte ME, Schreibelt G, de Vries HE. Radical changes in multiple sclerosis pathogenesis. Biochim Biophys Acta. 2011;1812(2):141-50.
4. Caprio MG, Russo C, Giugliano A, Ragucci M, Mancini M. Vascular Disease in Patients with Multiple Sclerosis. J Vasc Med Surg. 2016;4:259.
5. Ross R. Atherosclerosis-an inflammatory disease. N Engl Med J. 1999;340(2):115-26.
6. O’Keefe JH, Carter MD, Lavie CJ. Primary and secondary prevention of cardiovascular diseases: a practical evidence-based approach. Mayo Clin Proc. 2009;84:741-57.
7. Sevim S. Multipl Skleroz Atakları Üzerine Güncelleme: Tanım, Patofizyoloji, Özellikler, Taklitçiler ve Tedavi. Turk J Neurol. 2016;22:99-108.
8. Ranadive SM, Yan H, Weikert M, Lane AD, Linden MA, Baynard T, et al. Vascular dysfunction and physical activity in multiple sclerosis. Med Sci Sports Exerc. 2012; 44(2): 238-43.

9. Christiansen CF, Christiansen S, Mehnert F, Cummings SR, Chapurlat RD, Sørensen HT. Glucocorticoid use and risk of atrial fibrillation or flutter: a population-based, case-control study. Arc Intern Med. 2009;169(18):1677-83.
10. Kamışlı Ö, Tecellioğlu M, Özcan A. Sekiz buçuk Sendromu ile Karşımıza çıkan Multiple Skleroz Vakası. Kırıkkale Üniversitesi Tıp Fakültesi Dergisi. 2015;17(3):34-8.
11. Nerrant E, Tilikete C. Ocular Motor Manifestations of Multiple Sclerosis. J Neuroophthalmol. 2017;37(3):332-40.
12. Karataş M. Internuclear and Supranuclear Disorders of Eye Movement. Turk J Neurol. 2009;15(2):54.