Fulminant multiple sclerosis (MS)

Area of Science:

• Neurology
• Neuroimmunology

Background:

• Fulminant multiple sclerosis (MS) is a rare, aggressive form of MS with a typically rapid and fatal course.
• Optic neuritis (ON) can be an early symptom of MS, but a long interval between ON and fulminant MS onset is unusual.

Observation:

• A 30-year-old woman presented with rapid neurological deterioration, progressing to a vegetative state and experiencing a seizure.
• She had a history of optic neuritis (ON) one year prior to the severe MS onset.
• Brain MRI revealed multiple T2 hyperintense white matter lesions, consistent with demyelinating disease.

Findings:

• This case represents a rare presentation of fulminant MS with a significant one-year history of preceding optic neuritis.
• The patient's rapid decline and seizure activity, coupled with prior ON, distinguish this case from typical fulminant MS presentations.
• Differential diagnoses for rapidly progressive leucoencephalopathy were considered, but MS was the most likely diagnosis given the clinical and radiological evidence.

Implications:

• This case underscores the importance of considering MS in patients with a history of ON who develop rapid neurological decline.
• Prompt diagnosis and aggressive treatment, potentially including plasmapheresis and cyclophosphamide, may improve prognosis if initiated before significant brain atrophy occurs.
• Further research into the long-term implications of delayed presentations of fulminant MS is warranted.