A Case of a 40‐year‐old Female with Speech Disturbance

A 40-year-old Caucasian female with a history of migraines and depression presented to the emergency department for word-finding difficulty, speech disturbances, and “feeling off” for two days. Her husband reported that it sounded like she had a lisp when she spoke. She endorsed brain fog but denied fever, chills, headache, dysuria, focal weakness, or numbness/tingling. She denied a social history of smoking, alcohol, or drug use. She was otherwise healthy with no other medical or surgical history, including no history of stroke, cardiovascular disease, or other neurologic issues outside of migraines. Imaging showed multiple enhancing white matter lesions consistent with demyelination. An initial diagnosis of multiple sclerosis was given, and she completed 5 days of high-dose steroids. The patient would return to the hospital within a few days of discharge after developing left-sided weakness. Over the next month, the patient's demyelinating lesions would become tumefactive, with characteristic concentric rings seen in Baló's concentric sclerosis. She had oligoclonal bands in her CSF, and the brain biopsy was consistent with a demyelinating lesion, but otherwise her work-up was unremarkable. Despite treatment with steroids, plasmapheresis, immunoglobulins, and cyclophosphamide, the patient's neurologic status rapidly declined, and she succumbed to sepsis (Figures 1-5). Baló's concentric sclerosis [1]. The authors have nothing to report. The authors declare no conflicts of interest. Data sharing not applicable to this article as no datasets were generated or analysed during the current study.