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Early predictors of rapidly evolving multiple sclerosis: A case report.

Publication ,  Journal Article
Fernando, KTM; James, M
Published in: J Neuroimmunol
June 15, 2017

UNLABELLED: Objective The aim of this case report is to highlight some important features of rapidly evolving Multiple Sclerosis. BACKGROUND: In a small proportion of patients, Multiple Sclerosis (MS) can present as a fulminant disease characterised by severe and frequent relapses. This form of rapidly evolving MS is associated with significant morbidity and mortality. It is therefore important to identify these patients as early as possible, so that they can be managed effectively. However, due to the rarity of fulminant forms of MS, there is limited data on the natural history and management of this condition. CASE REPORT: We present a young man with rapidly evolving Multiple Sclerosis (MS) who had 2 disabling relapses within 14weeks. He had an unusually high CSF white cell count at presentation (86per mm3; 100% lymphocytes, 97% T cells, 3% B cells), with positive oligoclonal bands. Brain MRI showed large, cavitating lesions, with no enhancement. He required a prolonged course of intravenous methyl-prednisolone and plasma exchange. CONCLUSIONS: This case suggests that male gender, young age at onset, time to second relapse, relapse severity, high CSF white cell count at presentation, large and cavitating lesions on MRI may be early predictors of rapidly evolving MS. It also highlights the therapeutic value of plasma exchange and longer courses of intravenous methylprednisolone in managing severe MS relapses. Enhancement may not always be a reliable indicator of disease activity, particularly in clinical settings where single dose gadolinium is used, due to its low sensitivity in detecting blood brain barrier leakage.

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Published In

J Neuroimmunol

DOI

EISSN

1872-8421

Publication Date

June 15, 2017

Volume

307

Start / End Page

42 / 46

Location

Netherlands

Related Subject Headings

  • Neurology & Neurosurgery
  • Multiple Sclerosis
  • Male
  • Magnetic Resonance Imaging
  • Immunologic Factors
  • Immunoglobulins, Intravenous
  • Image Processing, Computer-Assisted
  • Humans
  • Disability Evaluation
  • Brain
 

Citation

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ICMJE
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Fernando, K. T. M., & James, M. (2017). Early predictors of rapidly evolving multiple sclerosis: A case report. J Neuroimmunol, 307, 42–46. https://doi.org/10.1016/j.jneuroim.2017.03.017
Fernando, Kryshani T. M., and Michael James. “Early predictors of rapidly evolving multiple sclerosis: A case report.J Neuroimmunol 307 (June 15, 2017): 42–46. https://doi.org/10.1016/j.jneuroim.2017.03.017.
Fernando KTM, James M. Early predictors of rapidly evolving multiple sclerosis: A case report. J Neuroimmunol. 2017 Jun 15;307:42–6.
Fernando, Kryshani T. M., and Michael James. “Early predictors of rapidly evolving multiple sclerosis: A case report.J Neuroimmunol, vol. 307, June 2017, pp. 42–46. Pubmed, doi:10.1016/j.jneuroim.2017.03.017.
Fernando KTM, James M. Early predictors of rapidly evolving multiple sclerosis: A case report. J Neuroimmunol. 2017 Jun 15;307:42–46.
Journal cover image

Published In

J Neuroimmunol

DOI

EISSN

1872-8421

Publication Date

June 15, 2017

Volume

307

Start / End Page

42 / 46

Location

Netherlands

Related Subject Headings

  • Neurology & Neurosurgery
  • Multiple Sclerosis
  • Male
  • Magnetic Resonance Imaging
  • Immunologic Factors
  • Immunoglobulins, Intravenous
  • Image Processing, Computer-Assisted
  • Humans
  • Disability Evaluation
  • Brain