Rev Neurol 2001 Dec 1;33(11):1046-8
INTRODUCTION.
We wish to discuss the value of the
clinical history and examination in orientation of the diagnosis of probable
multiple sclerosis (MS).
CLINICAL CASE.
We report the two year study of a
woman who over the previous ten years had had three episodes of paraesthesia,
with pins and needles in her left leg and other parts of the left side
of her body, although never affecting head or neck. She also complained
of tiring more than usual. In an outpatient clinic she was found to have
a syndrome affecting the upper segments of the spinal cord, mainly involving
the right side and resembling an incomplete Brown Sequard type syndrome.
There were increased clinical muscle and deep reflexes. The most marked
was that of the right deltoid (C5), bilateral fanning of the toes when
the Babinski reflex was tested, Barre positive in the right leg, pins and
needles and dysaesthesia on the left to an undetermined level. Function
was well preserved when compared with the clinical signs found. The case
was considered to be of monotopical MS. Spinal magnetic resonance findings
confirmed the clinical diagnosis.
CONCLUSIONS.
We emphasise the value of careful
clinical investigation directed towards the diagnosis of probable MS. We
draw attention to the diagnostic value of the dissociation between the
severe clinical alterations and the functional performance, which was surprisingly
well maintained. Also we report the originality of the presence of bilateral
fanning sign supporting the diagnosis of MS, occurring in a disease of
adult life.
Barraquer Bordas L.