Abstract General Information
Parkinsonism as rare manifestation of acute multiple sclerosis
Case presentation: A 21-year-old right-handed boy with tremor and incoordination. Symptoms started in December 2019 with tremor associated with memory symptoms and worsened until March 2020 when appeared sluggishness in carrying out activities, tremors in the trunk and limbs. In August 2020, he had difficulty walking associated with frequent falls and decreased strength in the lower limbs. In January 2021, he presented significant worsening of tremor and worsening of memory symptoms with episodes of auditory hallucinations. In June 2021, he presented with worsening gait and urinary incontinence. On neurologic examination there was resting tremor, plastic rigidity, and bradykinesia. He also had central facial palsy. Past medical history showed only generalized anxiety disorder. He denies previous use of medication, smoking, alcohol or illicit drug. No family history of similar symptoms, neurodegenerative disorders, or consanguinity. Neurological examination showed preserved higher mental functions, left central facial palsy, bilateral cogwheel rigidity, asymmetrical, worse on the left, action tremor in the upper limbs, bradykinesia in the upper limbs. He also presented sensory alterations of hypopalesthesia and hypoartryesthesia in bilateral feet. Trunk-limb dyssynergia, dysmetria, bilateral dysdiadochokinesi. In addition, drunken gait with impaired coordination in the right upper limb. EDSS was 4.0. MRI showed typical MS lesions in the skull, cervical and thoracic spinal cord. CSF showed BOC present. Treatment was performed with methylprednisolone 1g/day for 5 days, with significant improvement in symptoms.
Discussion: Movement disorders are considered uncommon in multiple sclerosis and their prevalence and incidence are unknown. In addition, there is a lack of consensus among authors. Some movement disorders are suggestive of multiple sclerosis, such as painful tonic spasm, although it appears to be more frequent in Neuromyelitis Optica.
Final Comments: The presence of movement disorders in patients with demyelinating diseases seems to be associated with the severity and progression of the disease.
Andreia Braga Mota Azzoni, Ivna Lacerda Pereira Nobrega, Milena Sales Pitombeira, Lucas Silvestre Mendes, Gabriela Joca Martins, José Artur Costa D'Almeida