SHM Converge Scientific Abstract ePoster Gallery-Family History Matters: Case of Acute Paralysis From Multiple Sclerosis

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This case report describes a 59-year-old man who presented with acute, progressive right-sided arm and leg weakness after an assault to the face. Although he denied direct neck injury, imaging revealed a contrast-enhancing intramedullary lesion at C2 with surrounding cord abnormality, concerning for active demyelination. Neurology was consulted, and lumbar puncture showed cerebrospinal fluid oligoclonal bands and elevated myelin basic protein. Other causes of demyelinating disease and infection were excluded, including AQP4/NMO, RPR, HIV, and MOG antibodies. <br /><br />The patient had a striking family history of multiple sclerosis, including a younger sister and a niece with MS. Based on the clinical presentation, MRI findings, CSF studies, and family history, he was diagnosed with multiple sclerosis and treated promptly with high-dose IV steroids for five days followed by an oral prednisone taper. He also received physical and occupational therapy, with improvement in strength and mobility. He was discharged for outpatient neurology follow-up and had largely regained mobility one month later.<br /><br />The discussion reviews key epidemiology and risk factors for MS. MS is the most common immune-mediated inflammatory demyelinating disease of the central nervous system, typically presenting at age 28–31, though this patient was older than usual. It affects about 900,000 people in the U.S. Etiology is multifactorial, with associations including Epstein-Barr virus infection, geographic latitude, vitamin D exposure, and strong genetic predisposition. First-degree relatives have a markedly increased risk, and twin studies show higher concordance in monozygotic twins.<br /><br />The report emphasizes that in patients with acute paralysis, MS should remain in the differential diagnosis, especially when imaging and CSF support demyelination. Early treatment is important to improve neurologic recovery.

Asset Subtitle

Yoo Mee Shin

Meta Tag

Author List Bashir Geer, Joyce Rankin, Shaunak Varma, Yoo Mee Shin

Category Clinical Vignettes

Concept Multiple Sclerosis

Concept Magnetic Resonance Imaging

Concept Oligoclonal Bands

Concept High-Dose Corticosteroid

Concept Epstein-Barr Virus

Distinguished Non-Finalist

Presenter Organization Emory University

Presenting Author Yoo Mee Shin

Track Adult

Keywords

multiple sclerosis

demyelination

intramedullary lesion

cervical spinal cord

oligoclonal bands

myelin basic protein

high-dose IV steroids

acute paralysis

family history

neurology consultation

Multiple Sclerosis

Magnetic Resonance Imaging

Oligoclonal Bands

High-Dose Corticosteroid

Epstein-Barr Virus