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Título

Depersonalization as a Symptom of a Parieto-Occipital Lesion in a Patient with Relapsing Remitting Multiple Sclerosis: A case report

RESUMO

Case report
In june 2021, a 52-year-old female with relapsing remitting multiple sclerosis (MS) since the age of 14 with left hemiplegia, attended to an outpatient follow-up with a history of 4 monthly episodes of temporal disorientation and disorganized thinking in the past few years, after one of the MS outbreaks. Each episode begins by waking up; lasts throughout the day; ends at bedtime. While in this situation, the patient describes that she watches her body from above, also, she cannot perform a sequence of tasks properly, also she notices a change in processing speed, characterizing a depersonalization disorder. The patient underwent a new brain MRI that showed a focal T2 hypersignal in the subcortical white matter of the right frontal lobe present in a previous exam and a new lesion in the right parieto-occipital subcortical white matter next to the posterior horn of the lateral ventricle with hypersignal in T2 and FLAIR and no gadolinium enhancement that might temporarily correspond to the onset of the current symptom.

Discussion
Cognitive impairments and MS are often related, suggesting they are associated with the demyelination process. This finding is more common in patients with progressive MS. Most cases report deficits in episodic memory and processing speed, although symptoms such as verbal fluency, visuospatial analysis, difficulty in multitasking and in word finding may occur. These declines often begin early in disease, being one of the major concerns of the patients once they are diagnosed. Besides cognition, psychiatric symptoms are also reported in some MS phenotypes, including psychosis, depersonalization. Despite the link between the relapse and the depersonalization, it is more frequently seen the association between MS and cognitive disorders. Also, neuropsychiatric disorders appeared in a bigger percentage associated with frontal lobe lesions.

Final Comments
Cognitive disorders and behavioral symptoms may be associated with multiple sclerosis outbreaks and represent an important factor to the patient’s quality of life. In this patient, the parieto-occipital lesion in the new MRI correlates with symptom onset, suggesting a possible correlation between that region and depersonalization. Although not described before, it could be attributed to the spatial recognition function of the parietal lobe, prompting more studies regarding the correlation of depersonalization and its topography.

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Área

Neuroimunologia