Cerebral metabolism in a case of multiple sclerosis with acute mental disorder

Area of Science:

• Neurology
• Neuroscience
• Psychiatry

Background:

• Acute mental disorder is a rare manifestation in early Multiple Sclerosis (MS).
• Limited understanding exists regarding the structural and metabolic brain changes associated with these acute mental changes in MS.
• Early diagnosis and characterization of neurological and psychiatric symptoms in MS are crucial for effective management.

Observation:

• A patient with early Multiple Sclerosis (MS) presented with subtle motor and sensory deficits.
• Over nine months, the patient developed severe behavioral and mental changes during the initial disease course.
• The patient underwent comprehensive neuropsychological testing, Magnetic Resonance Imaging (MRI), and Positron Emission Tomography (PET) for metabolic assessment.

Findings:

• Positron emission tomography (PET) revealed significantly reduced cerebral metabolic rate of glucose (CMRglc) bilaterally in the frontal and temporal cortex, putamen, thalamus, and hippocampus.
• MRI demonstrated progression of MS lesions in the frontal lobes coinciding with the onset of mental symptoms.
• Neuropsychological evaluation indicated widespread cognitive dysfunction and a pronounced frontal lobe syndrome.

Implications:

• This case highlights the potential for remote metabolic effects of MS lesions on subcortical neural connections.
• The findings suggest that structural changes in MS can lead to significant cognitive and behavioral disturbances.
• Understanding these metabolic changes is vital for diagnosing and managing psychiatric and cognitive dysfunction in Multiple Sclerosis.