Coexistent Mitral Stenosis and Multiple Sclerosis: An Unprecedented Case

Mitral stenosis is a valvular heart disease characterised by narrowing of mitral orifice. It can lead to a dilated left atrium with atrial fibrillation culminating into thrombus formation. Patients with mitral stenosis, presenting with stroke-like episodes, most likely experience cardio-embolic phenomenon; but unusual and unprecedented associations do occur. Reported association of cardiac MS with demyelinating CNS MS has never been proven; but authors have speculated theories based on case reports and series. We narrate the case of a 28-year gentleman known to have severe mitral stenosis, who presented with history of multiple stroke-like episodes. During each episode, he had CT brain done and was labelled as having recurrent embolic strokes. We investigated in detail, and the patient was found to have classical MRI features and CSF findings of multiple sclerosis with multiple lacunar infarcts, warranting different line of treatment in addition to cardio-embolic strokes.