Tonic spasms and demyelinating lesions

Case scenario

A 39-year-old mother of two children who had been working very hard and studying presented with exhaustion, recurrent headaches and some features of depression. She also mentioned that she had experienced frequently recurring ‘shudders’ down the left side of her body, which she had attributed to her chronic tiredness. Over the previous few months, she also felt that her speech had been slurred at times, but again she attributed this to fatigue. A full neurological examination at the time was normal.

Shortly after this presentation, the patient experienced an acute episode of dysarthria and severe left-sided spasms, weakness and incoordination. An urgent MRI brain scan revealed three lesions: one deep in her left frontal area, a second in the left parietal region and a third in the pons. The lesions were reported as being consistent with a demyelinating process. The patient had no previous neurological problems and in particular no history of visual or bladder disturbance.