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[Paroxysmic anarthria in multiple sclerosis]
A Arjona1, E Fernández-Romero, R Espino
1Neurólogo, Hospital Cruz Roja Española, Córdoba, España. arjona@teleline.es
Introduction:
The paroxystic clinical features of multiple sclerosis (MS) include trigeminal neuralgia, itch, transient diplopia, Lhermitte's sign, akinesia, dystonia, Uhthoff's phenomenon and others which are very characteristic, such as paroxystic ataxia and dysarthria.
Clinical Case:
We present the case of a 30 year old man who consulted for multiple episodes lasting only a few seconds, of complete inability to speak. This symptom recurred several times a day and in many different situations. It was often triggered off by external stimuli such as having to speak in front of several people. The disorder disappeared without treatment seven days after onset. Magnetic resonance using fast spin echo image sequences showed multiple hyperintense lesions in mid right cerebellar peduncle, right pons, left temporal lobe, white substance of both internal capsules, periventricular and semioval centres. Biochemical study of the cerebrospinal fluid showed that there were 9 cells/microliter (mainly lymphocytes), proteins 45 mg/dl and a normal glucose level. The Tibling-Link level was 0.73. Cortical somestesic evoked potentials showed slowed conduction after stimulation of the right median nerve and both peroneal nerves. Acoustic evoked potentials of the brain stem were conducted more slowly by the right acoustic pathway at intraxial level. The patient was diagnosed as having clinically defined MS.
Conclusions:
We consider that our patient's symptom was a kind of paroxystic dysarthria which we call paroxystic anarthria. Differential diagnosis of this symptom should be basically with phonatory or dysphasic simple partial seizures.
Insights
A man experienced brief episodes of complete inability to speak, diagnosed as paroxysmal anarthria, a form of paroxysmal dysarthria in multiple sclerosis (MS). This rare symptom resolved spontaneously within a week.
Area of Science:
- Neurology
- Neuroscience
- Clinical Medicine
Background:
- Multiple sclerosis (MS) presents with diverse paroxysmal symptoms, including ataxia and dysarthria.
- Understanding these transient neurological events is crucial for accurate MS diagnosis and management.
Observation:
- A 30-year-old male presented with recurrent, brief episodes of complete speechlessness, often triggered by social situations.
- These episodes resolved spontaneously within seven days without intervention.
- MRI revealed characteristic MS lesions in the cerebellum, pons, temporal lobe, and internal capsules.
Findings:
- The patient's symptom was identified as paroxysmal anarthria, a specific type of paroxysmal dysarthria.
- Evoked potential studies indicated slowed nerve conduction in sensory and auditory pathways.
- Cerebrospinal fluid analysis showed mild lymphocytic pleocytosis, consistent with MS.
Implications:
- Paroxysmal anarthria should be considered in the differential diagnosis of speech disturbances in MS.
- Distinguishing this symptom from epileptic seizures is essential for appropriate patient care.
- This case highlights the varied and sometimes unusual presentations of multiple sclerosis.