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

Öz

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.

Anahtar Kelimeler

• Multiple Sclerosis,ischemic stroke,atherosclerosis

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

Öz

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.

Anahtar Kelimeler

• Multipl Skleroz,iskemik inme,ateroskleroz

Kaynakça

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