Cadasil, Migraine and Multiple Sclerosis (MS)-The Risk of Misdiagnosis, Case Report
Journal Title: Modern Approaches in Dentistry and Oral Health Care - Year 2018, Vol 2, Issue 5
Abstract
Diagnostic criteria for multiple sclerosis (MS) have been changing for years to enable easier and faster ways to confirm diagnosis especially during last decade. They lead to earlier treatment of patients with MS what gives higher likelihood to keep patients fit and capable of working. Dissemination in time (DIT) and in space (DIS) are general rules which are necessary to diagnose MS what was maintained in all diagnostic criteria, which have been published up till now[1]. Current criteria were published in 2017 and enable diagnosing MS even in patients, who earlier could not have MS diagnosed. This results from the facts that CSF oligoclonal bands present in patients with DIS without DIT are enough to MS diagnose[2]. Cerebral Autosomal Dominant Arteriopathy with Subcortical Infarcts and Leucoencephalopathy (CADASIL) is a disease of small vessels related to gene NOTCH3 mutations leading to symptoms of migraine with aura, recurrent ischaemic incidences, cognitive impairment and behavioural disturbance. In this paper we describe patient forty one years old woman in October of 2012, who was hospitalized in Neurological Ward due to headache, dizziness and numbness of left extremities.Physical examination showed excessive deep reflexes in all extremities and Babinski sign present bilaterally. Computed tomography (CT) revealed multifocal lesions placed subcortically and periventricular. Magnetic resonance imaging (MRI) enabled to visualize numerous hyperintensive lesions in T₂-weighted projection, situated in white mater of both hemispheres, periventricularly, corpus callous lobe, semioval centres. There were no lesions subtentorially located or enhancing after contrast injection.After that, cerebrospinal fluid was tested cytosis 1/μL, protein 20, 6mg/dl, glucose 62, 7mg/dl and oligoclonal bands were absent.Therefore, at that moment, MS diagnose was established. Patient was treated using SoluMedrol following which health ailments needed.Two months later, in December of 2012, MRI scan of the cervical spinal cord did not reveal any lesions.After two years, in March of 2014, right-sided paraesthesia appeared with concentration disturbances whereas physical examination revealed excessive deep reflexes.
Authors and Affiliations
Piotr Bogucki, Paulina Felczak, Teresa Wierzba Bobrowicz, Halina Sienkiewicz-Jarosz, Urszula Fiszer
Keywords
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- EP ID EP614967
- DOI 10.32474/MADOHC.2018.02.000148
- Views 68
- Downloads 0
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