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Fluctuating neurological symptoms in demyelinating disease mimicking an acute ischaemic stroke

Montserrat G Delgado1, Elena Santamarta, Antonio Sáiz

  • 1Neurology Service, Hospital Universitario Central de Asturias, Oviedo, Spain. mglezdelgado@yahoo.es

BMJ Case Reports
|May 19, 2012
PubMed

Insights

Demyelinating disease, not just stroke, should be considered in older adults with fluctuating neurological symptoms. Early diagnosis via MRI and CSF analysis is crucial for effective corticosteroid treatment.

Area of Science:

  • Neurology
  • Neuroimmunology

Background:

  • Fluctuating neurological symptoms in elderly patients are often misdiagnosed as cerebral ischemic events.
  • This case highlights the importance of considering alternative diagnoses beyond stroke.

Observation:

  • A 66-year-old male presented with fluctuating right hemiparesis, initially suspected as an ischemic stroke.
  • Cervical and brain Magnetic Resonance Imaging (MRI) revealed demyelinating lesions.
  • Cerebrospinal fluid (CSF) analysis and visual evoked potentials (VEPs) were abnormal.

Findings:

  • The patient was successfully treated with intravenous corticosteroids.
  • The findings suggest demyelinating disease is a potential cause of fluctuating neurological deficits in older individuals.
  • MRI and CSF analysis are critical for accurate diagnosis.

Implications:

  • Demyelinating diseases may be underdiagnosed in the elderly population.
  • Clinicians should consider demyelinating conditions in older patients presenting with fluctuating neurological symptoms.
  • Prompt diagnosis and treatment with corticosteroids can lead to positive patient outcomes.

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