Dados do Trabalho

Título

Primarily progressive multiple sclerosis with late presentation

RESUMO

Male patient, 67 years old, without comorbidities, five years ago he started a postural imbalance, weakness of the lower limbs and falls. Four months ago, he presented: mental confusion; apathy; attention alteration; excessive sleepiness; depressed mood, dysphagia; major dysarthria; urinary incontinence and became bedridden.
At hospital admission, on neurological examination, he was disoriented and uncooperative, dysarthric, with emotional lability, tetrasegmental hypotrophy, elastic hypertonia and hyperreflexia with signs of pyramidal release, reduced strength, worse in lower limbs.
In the imaging exams, the patient presented characteristic lesions of multiple sclerosis, comparing magnetic resonance imaging of the brain performed in a period of one year, the disease activity is visible, demonstrated by the contrast enhancement in some the lesion areas. Multiple lesions were defined in the periventricular white matter, subcortical, corona radiata, in the left portion of the pons and in the right cerebral peduncle, most with a perivenular aspect (Dawson's fingers), some with contrast enhancement.
In the cerebral spinal fluid: leukocytes: 2, proteins: 100; albumin: 56.2 / gamma: 15.7 / total proteins: 118 / presence of suggestive band in the gamma region; IgG: 17.2 / IgM: 163; Serum protein immunofixation: IgG: 907 / IgM: 159. No monoclonal bands were detected. Serum albumin 3.67g/dL CSF IgG index was 1.24.
The investigation of neoplasms was performed, and did not show lesions.
The patient and the family were oriented about the prognosis of the disease and was improved the clinical support.
Multiple sclerosis (MS) is the most common immune-mediated inflammatory demyelinating disease of the central nervous system, the mean age of MS onset ranges from 28 to 31 years; clinically it becomes apparent between the ages of 15 to 45. Clinical onset rarely occurs in the first years of life or after the seventh decade.
In only about 5% of cases, MS is diagnosed after age 50. There is growing concern of a more progressive form of MS in late-onset cases. Unlike adult-onset MS, the first presentation of the late form is usually motor dysfunction.
This case report exemplifies what we see in the literature, although it is uncommon, late presentation, after 50 years of age, occurs, and has some characteristics such as the onset with a motor condition. It is important to emphasize unusual presentations so that we do not fail to recognize them and manage to treat them earlier.

Palavras Chave

Central Nervous System; demyelinating; atypical;