Multiple sclerosis as a cause of atrial fibrillation and electrocardiographic changes

We present the case of a young woman with an acute exacerbation of multiple sclerosis associated with paroxysmal atrial fibrillation and electrocardiographic changes characteristic of central nervous system effects on cardiac conduction. The patient presented with ataxia, vertigo, and left facial paresthesia, and was found to have a large demyelinating lesion involving the left middle and inferior cerebellar peduncles with extension rostrally into the brain stem. Profound pulmonary edema, out of proportion with the cardiac abnormalities, also developed. This confirms that demyelinating disease, like other central nervous system abnormalities, can lead to alterations in cardiac conduction, and may induce neurogenic pulmonary edema.