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Multiphasic disseminated encephalomyelitis presenting as alternating hemiplegia
Journal of Neurology, Neurosurgery, and Psychiatry
|April 1, 1995
Summary
Two cases of alternating hemiparesis in Sudanese and Saudi patients suggest multiphasic disseminated encephalomyelitis over multiple sclerosis. MRI findings, though unusual, aided diagnosis, potentially reducing the need for brain biopsies.
Area of Science:
- Neurology
- Neuroimmunology
- Radiology
Background:
- Alternating hemiparesis is a rare neurological condition characterized by recurrent, temporary weakness on alternating sides of the body.
- Distinguishing between multiphasic disseminated encephalomyelitis (MDEM) and multiple sclerosis (MS) can be challenging, especially with atypical presentations.
Observation:
- Two patients, a black Sudanese woman and a Saudi man, presented with recurrent episodes of alternating hemiparesis.
- Magnetic Resonance Imaging (MRI) revealed characteristic but unusual lesions.
- Brain biopsies were performed, confirming the diagnosis of MDEM.
Findings:
- The clinical course and MRI findings supported a diagnosis of MDEM, differentiating it from MS.
- The specific MRI lesion appearance was key in diagnosis, distinguishing it from recurrent disseminated encephalomyelitis where lesions are stereotyped and new lesions do not appear.
Implications:
- Recognizing the specific MRI characteristics of MDEM in alternating hemiparesis can obviate the need for invasive brain biopsies.
- This finding may refine diagnostic criteria and improve patient management for rare neuroinflammatory conditions.