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Multiple sclerosis presenting as late functional deterioration after poliomyelitis
E Chroni1, R S Howard, C P Panayiotopoulos
1Lane-Fox Unit, Guy's Hospital Trust, London, UK.
Abstract:
We describe five patients with previous poliomyelitis who developed multiple sclerosis (two laboratory supported definite and three clinically definite). The initial symptoms of functional deterioration developed a mean of 30 years following poliomyelitis. Initial functional deterioration was due to progressive limb weakness or impaired mobility and in three cases this led to an initial diagnosis of post-polio muscular atrophy. The clinical diagnosis became apparent with the subsequent development of characteristic clinical features, including optic nerve, brainstem, cerebellum, and spinal cord involvement. The occurrence of multiple sclerosis in these patients emphasises that late functional deterioration may be apparently unrelated to previous poliomyelitis. Furthermore, characteristic clinical features may be masked by the severe pre-existing neuromuscular and orthopaedic impairment leading to diagnostic delay and confusion with the ill-defined clinical syndrome of progressive post-polio muscular atrophy.
Insights
Patients with a history of poliomyelitis can develop multiple sclerosis decades later. New neurological symptoms may mimic post-polio syndrome, delaying diagnosis of this distinct condition.
Area of Science:
- Neurology
- Neuroimmunology
- Infectious Disease Epidemiology
Background:
- Poliomyelitis survivors may experience late-onset functional decline.
- Distinguishing new neurological conditions from post-polio sequelae can be challenging.
Observation:
- Five patients with prior poliomyelitis developed multiple sclerosis (MS) an average of 30 years post-infection.
- Initial symptoms included progressive limb weakness and mobility issues, leading to misdiagnosis as post-polio muscular atrophy in some cases.
Findings:
- Multiple sclerosis diagnosis was confirmed by characteristic neurological signs affecting the optic nerve, brainstem, cerebellum, and spinal cord.
- Late-onset functional deterioration in poliomyelitis survivors may be unrelated to the original infection.
Implications:
- This highlights the importance of considering multiple sclerosis in poliomyelitis patients with new neurological deterioration.
- Severe pre-existing impairments can mask MS symptoms, necessitating thorough diagnostic evaluation to avoid confusion with progressive post-polio muscular atrophy.