Acute Spinal Cord Syndrome As the Initial Manifestation of Multiple Sclerosis: A Case Report

Multiple sclerosis (MS) typically presents with optic neuritis, brainstem syndromes, or sensory disturbances. Isolated spinal cord involvement as the initial manifestation occurs in fewer than 30% of cases, making early recognition challenging but essential for timely diagnosis and treatment initiation. A previously healthy 22-year-old Caucasian male presented with an acute onset of mid-thoracic pain followed by progressive sensory deficits below the T10 dermatome and lower limb weakness developing over five days. Neurological examination revealed spastic paraparesis (Medical Research Council grade 3/5), sensory level at T10, and hyperreflexia with bilateral Babinski signs. Magnetic resonance imaging (MRI) of the spinal cord demonstrated two focal T2-hyperintense intramedullary lesions at T1-T2 and T11 levels with gadolinium enhancement. Brain MRI revealed a single periventricular lesion consistent with demyelination. Cerebrospinal fluid analysis showed lymphocytic pleocytosis (11 cells/µL), mildly elevated protein (52 mg/dL), and two oligoclonal bands restricted to cerebrospinal fluid (CSF). The patient received high-dose intravenous methylprednisolone (1 g daily for three days) with significant neurological improvement. At the three-month follow-up, motor strength had improved to grade 4/5 with residual mild sensory deficits. This case illustrates the diagnostic challenges of MS presenting as isolated spinal cord syndrome. Early spinal MRI and CSF analysis are crucial for accurate diagnosis and prompt therapeutic intervention, potentially improving long-term outcomes.