Multiple sclerosis or multiphasic disseminated encephalomyelitis? A new question about an old problem: case report

Maranhão-Filho, Pérciles A.

doi:10.1590/S0004-282X1996000300024

Abstracts

A 42 year-old woman developed paraplegia that resolved in six months, followed by sudden right hemiparesis and dysphasia two years later. The clinical work-up, including CT and MR scans, visual evoked potentials, CSF examination and cerebral biopsy suggested the posibility of either multiple sclerosis or multiphasic disseminated encephalomyelitis. The differential diagosis between both conditions is discussed.

multiphasic disseminated encephalomyelitis; multiple sclerosis; magnetic resonance imaging

Relato de caso de uma mulher com 42 anos de idade, que apresentou paraplegia, com resolução em seis meses seguida por hemiparesia direita e disfasia de ínico súbito. Sua história, os aspectos da tomografia computadorizada e da ressonância magnética do crânio, os resultados do potencial evocado visual, do exame do líquido cérebroespinhal, da biópsia cerebral e da ressonância magnética de controle, sugeriram as possibilidade diagnosticas de esclerose múltipla ou encefalomielite disseminada multifásica. O diagnóstico diferencial entre ambas é discutido.

encefalomielite disseminada multifásica; esclerose múltipla; ressonância magnética

Multiple sclerosis or multiphasic disseminated encephalomyelitis? A new question about an old problem: case report

Esclerose múltipla ou encefalomielite disseminada multifásica? Uma nova questão sobre um antigo problema: relato de caso

Pérciles A. Maranhão-Filho

Neurologist, Department of Neurosurgery, National Institute of Cancer (INCa).Rio de Janeiro, Brazil

ABSTRACT

A 42 year-old woman developed paraplegia that resolved in six months, followed by sudden right hemiparesis and dysphasia two years later. The clinical work-up, including CT and MR scans, visual evoked potentials, CSF examination and cerebral biopsy suggested the posibility of either multiple sclerosis or multiphasic disseminated encephalomyelitis. The differential diagosis between both conditions is discussed.

Key words: multiphasic disseminated encephalomyelitis, multiple sclerosis, magnetic resonance imaging.

RESUMO

Relato de caso de uma mulher com 42 anos de idade, que apresentou paraplegia, com resolução em seis meses seguida por hemiparesia direita e disfasia de ínico súbito. Sua história, os aspectos da tomografia computadorizada e da ressonância magnética do crânio, os resultados do potencial evocado visual, do exame do líquido cérebroespinhal, da biópsia cerebral e da ressonância magnética de controle, sugeriram as possibilidade diagnosticas de esclerose múltipla ou encefalomielite disseminada multifásica. O diagnóstico diferencial entre ambas é discutido.

Palavras-chave: encefalomielite disseminada multifásica, esclerose múltipla, ressonância magnética.

Texto completo disponível apenas em PDF.

Full text available only in PDF format.

Acknowledgement - The author wish to thank Dr. Maurice Vicent and Prof. Mitchel A. Robuck Jr. for manuscript preparation assistance.

Aceite: 18-março-1996.

Dr. Péricles de Andrade Maranhão Filho - Av. Canal de Marapendi 1680/1802 - 22631-050 Rio de Janeiro RJ -Brasil. Fax 5521 439-5594.

1. Giang DW, Poduri KR, Eskin TA, Ketonen LM, Friedman PA, Wung DD, Herndon RM. Multiple sclerosis masquerading as a mass lesion. Neuroradiology 1992;34:150-154.
2. Giitling E, Landis T. CT ring sign imitating tumor, disclosed as multiple sclerosis by MRI: a case report. J Neurol Neurosurg Psychiatry 1989;52:903-906.
3. Hunter SB, Ballinger WE Jr, Rubin JJ. Multiple sclerosis mimicking primary brain tumor. Arch Pathol Lab Med 1987;111:464-468.
4. Khan S, Yaqub B A, Poser CM, Al Deeb SM, Bohlega S. Multiphasic disseminated encephalomyelitis presenting as alternating hemiplegia. J Neurol Neurosurg Psychiatry 1995;58:467-470.
5. Kepes JJ. Large focal tumor-like demyelinating lesions of the brain: intermediate entity between multiple sclerosis and acute disseminated encephalomyelitis? a study of 31 patients. Ann Neurol 1993;33:18-27.
6. Lecky BRF, Jeyagopal N, Smith ETS, Foy PM. Cerebral CT lesions in multiple sclerosis mimicking multiple metastases (Letter). J Neurol Neurosurg Psychiatry 1991 ;54:92.
7. Maranhão-Filho PA, Moraes-Filho L, Câmara LSA, Salema CC. Fulminant form of multiple sclerosis simulating brain tumor a case with parkinsonian features and pathologic study. Arq Neuropsiquiatr 1995;53:503-508.
8. Miller H, Cendrowski W, Schapira K. Multiple sclerosis and vacination. Br Med J 1967;2:210-213.
9. Miller H, Schapira K. Aetiological aspects of multiple sclerosis. Br Med J 1959;1:811-815.
10. Nesbit GM, Forbes GS, Scheithauer BW, Okazaki H, Rodriguez M. Multiple sclerosis: histopathologic and MR and/or CT correlation in 37 cases at biopsy and three cases at autopsy. Radiology 1991:180:467-474.
11. Paty DW, McFarlin DE, McDonald WI. Magnetic resonance imaging and laboratory aids in diagnosis of multiple sclerosis (Editorial) Ann Neurol 1991,29:3-5.
12. Poser CM. The epidemiology of multiple sclerosis: a general overview. Ann Neurol 1994;36(S2):S 180-S193.
13. Poser CM. The diseases of the myelin sheath.In Baker AB (ed). Clinical neurology. Philadelphia: Harper & Row, 1981:1-188.
14. Poser CM, Paty DW, Scheinberg L, McDonald I, Davis FA, Ebers GC, Johnson KP, Sibley WA, Silberberg DH, Wallace WT. New diagnostic criteria for multiple sclerosis: guidlines for research protocols. Ann Neurol 1983;13:227-231.
15. Tilbery CP, Guidugli-Neto J. Esclerose múltipla simulando tumor cerebral: apresentação de caso com comprovação histopatológia. Arq Neuropsiquiatr 1995;53:302-306.
16. Yahr MD, Lobo-Antunes J. Relapsing encephalomyelitis following the use of influenza vaccine. Arch Neurol 1972;27:182-183.
17. Zhang J. Multiple sclerosis perspectives on autoimune pathology and prospects for therapy. In Apple SH (ed). Current neurology 15. Chicago: Year Book, 1995:115-155.

Publication Dates

Publication in this collection
23 Nov 2010
Date of issue
Sept 1996

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

[1] 1. Giang DW, Poduri KR, Eskin TA, Ketonen LM, Friedman PA, Wung DD, Herndon RM. Multiple sclerosis masquerading as a mass lesion. Neuroradiology 1992;34:150-154.

[2] 2. Giitling E, Landis T. CT ring sign imitating tumor, disclosed as multiple sclerosis by MRI: a case report. J Neurol Neurosurg Psychiatry 1989;52:903-906.

[3] 3. Hunter SB, Ballinger WE Jr, Rubin JJ. Multiple sclerosis mimicking primary brain tumor. Arch Pathol Lab Med 1987;111:464-468.

[4] 4. Khan S, Yaqub B A, Poser CM, Al Deeb SM, Bohlega S. Multiphasic disseminated encephalomyelitis presenting as alternating hemiplegia. J Neurol Neurosurg Psychiatry 1995;58:467-470.

[5] 5. Kepes JJ. Large focal tumor-like demyelinating lesions of the brain: intermediate entity between multiple sclerosis and acute disseminated encephalomyelitis? a study of 31 patients. Ann Neurol 1993;33:18-27.

[6] 6. Lecky BRF, Jeyagopal N, Smith ETS, Foy PM. Cerebral CT lesions in multiple sclerosis mimicking multiple metastases (Letter). J Neurol Neurosurg Psychiatry 1991 ;54:92.

[7] 7. Maranhão-Filho PA, Moraes-Filho L, Câmara LSA, Salema CC. Fulminant form of multiple sclerosis simulating brain tumor a case with parkinsonian features and pathologic study. Arq Neuropsiquiatr 1995;53:503-508.

[8] 8. Miller H, Cendrowski W, Schapira K. Multiple sclerosis and vacination. Br Med J 1967;2:210-213.

[9] 9. Miller H, Schapira K. Aetiological aspects of multiple sclerosis. Br Med J 1959;1:811-815.

[10] 10. Nesbit GM, Forbes GS, Scheithauer BW, Okazaki H, Rodriguez M. Multiple sclerosis: histopathologic and MR and/or CT correlation in 37 cases at biopsy and three cases at autopsy. Radiology 1991:180:467-474.

[11] 11. Paty DW, McFarlin DE, McDonald WI. Magnetic resonance imaging and laboratory aids in diagnosis of multiple sclerosis (Editorial) Ann Neurol 1991,29:3-5.

[12] 12. Poser CM. The epidemiology of multiple sclerosis: a general overview. Ann Neurol 1994;36(S2):S 180-S193.

[13] 13. Poser CM. The diseases of the myelin sheath.In Baker AB (ed). Clinical neurology. Philadelphia: Harper & Row, 1981:1-188.

[14] 14. Poser CM, Paty DW, Scheinberg L, McDonald I, Davis FA, Ebers GC, Johnson KP, Sibley WA, Silberberg DH, Wallace WT. New diagnostic criteria for multiple sclerosis: guidlines for research protocols. Ann Neurol 1983;13:227-231.

[15] 15. Tilbery CP, Guidugli-Neto J. Esclerose múltipla simulando tumor cerebral: apresentação de caso com comprovação histopatológia. Arq Neuropsiquiatr 1995;53:302-306.

[16] 16. Yahr MD, Lobo-Antunes J. Relapsing encephalomyelitis following the use of influenza vaccine. Arch Neurol 1972;27:182-183.

[17] 17. Zhang J. Multiple sclerosis perspectives on autoimune pathology and prospects for therapy. In Apple SH (ed). Current neurology 15. Chicago: Year Book, 1995:115-155.