Beyond the Stroke: A Case Report of Multiple Sclerosis

Multiple sclerosis is an inflammatory, autoimmune demyelinating condition and poses diagnostic challenges due to varied presentations. This case report presents a divergence from typical clinical presentations of multiple sclerosis (MS), as the initial presentation resembled symptoms of a brain stem stroke. Conventionally, MS suspicion arises in the presence of previous neurological deficits or signs of optic neuritis. This case emphasises the need for high suspicion of MS in a suspected stroke or transient ischaemic attack (TIA). A 29-year-old woman presented with symptoms characterised by crossed hemiparesis, reduced coarse touch sensation, and paraesthesia of face and upper limb, which initially mimicked symptoms of a brain stem stroke with a normal CT head. MRI revealed multiple hyperintense lesions indicative of demyelinating disease, likely MS. MRI contrast did not identify active lesions. Further investigations included a vasculitis screen, MOG antibodies, and serum angiotensin-converting enzyme (ACE) levels. Treatment with intravenous methylprednisolone for working diagnosis of clinically isolated syndrome (CIS), a classification subset of MS, resulted in symptomatic improvement. The patient responded well and had a lumbar puncture in neurology follow-up, confirming relapsing and remitting multiple sclerosis (RRMS) and was started on disease-modifying treatment (DMT). Diagnosis of MS relies on McDonald criteria, emphasising dissemination in time and space. Early intervention and familiarity with diagnostic criteria are crucial when dealing with MS. This case highlights the diagnostic complexities of MS and the importance of a comprehensive approach to clinical evaluation. A young patient presenting with progressive symptoms affecting activities of daily living should prompt urgent investigations for early initiation of treatment. Familiarity with diagnostic criteria and treatment options optimises patient care in MS management.