Case Report
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Acute Ischemic Stroke in a Patient with Multiple Sclerosis Presenting with Left Hemiplegia and Dysarthria

Year 2018, Volume: 20 Issue: 1, 97 - 100, 30.04.2018

Bahar Say Mehmet Tunç İlknur Yardımcı Murat Alpua Ufuk Ergün

https://doi.org/10.24938/kutfd.349222

Abstract

Endothelial dysfunction induced by
chronic inflammation in the central nervous system and associated
atherosclerosis increases the risk of cerebrovascular disease in Multiple
Sclerosis. A 54 years-old woman with multiple sclerosis (secondary
progressive), hypertension (regular) and EDSS score 6 was brought with sudden loss of power
on her left side as well as speech and swallowing disturbances after high dose
intravenous pulse steroid therapy. Acute infarcts with diffusion restriction
were observed in mesencephalon, cerebellar hemispheres and right side of pons
in diffusion MR which was requested in the emergency department. Carotid-vertebral
Doppler ultrasonography and transthoracic echocardiography performed to
investigate etiology of stroke were normal. Arrhythmia was not observed in
rhythm Holter evaluation. Routine laboratory tests, thrombosis and vasculitis
markers were found to be normal. Multiple Sclerosis and immobility were
considered as the cause of stroke for this patient. The possibility of stroke
and a non-attack pathology should always be kept in mind when Multiple
Sclerosis patients admit with a new onset neurological dysfunction.

Keywords

Multiple Sclerosis ischemic stroke atherosclerosis

References

  • Kutzelnigg A, Lassmann H. Pathology of multiple sclerosis and related inflammatory demyelinating diseases. In: Goodin DS, eds. Handbook of Clinical Neurology. 3rd ed. China: Elsevier B.V. 2014:15-58.
  • Werner P, Pitt D, Raine CS. Multiple sclerosis: altered glutamate homeostasis in lesions correlates with oligodendrocyte and axonal damage. Ann Neurol. 2001;50(2):169-80.
  • Van Horssen J, Witte ME, Schreibelt G, de Vries HE. Radical changes in multiple sclerosis pathogenesis. Biochim Biophys Acta. 2011;1812(2):141-50.
  • Caprio MG, Russo C, Giugliano A, Ragucci M, Mancini M. Vascular Disease in Patients with Multiple Sclerosis. J Vasc Med Surg. 2016;4:259.
  • Ross R. Atherosclerosis-an inflammatory disease. N Engl Med J. 1999;340(2):115-26.
  • O’Keefe JH, Carter MD, Lavie CJ. Primary and secondary prevention of cardiovascular diseases: a practical evidence-based approach. Mayo Clin Proc. 2009;84:741-57.
  • Sevim S. Multipl Skleroz Atakları Üzerine Güncelleme: Tanım, Patofizyoloji, Özellikler, Taklitçiler ve Tedavi. Turk J Neurol. 2016;22:99-108.
  • Ranadive SM, Yan H, Weikert M, Lane AD, Linden MA, Baynard T, et al. Vascular dysfunction and physical activity in multiple sclerosis. Med Sci Sports Exerc. 2012; 44(2): 238-43.
  • Christiansen CF, Christiansen S, Mehnert F, Cummings SR, Chapurlat RD, Sørensen HT. Glucocorticoid use and risk of atrial fibrillation or flutter: a population-based, case-control study. Arc Intern Med. 2009;169(18):1677-83.
  • Kamışlı Ö, Tecellioğlu M, Özcan A. Sekiz buçuk Sendromu ile Karşımıza çıkan Multiple Skleroz Vakası. Kırıkkale Üniversitesi Tıp Fakültesi Dergisi. 2015;17(3):34-8.
  • Nerrant E, Tilikete C. Ocular Motor Manifestations of Multiple Sclerosis. J Neuroophthalmol. 2017;37(3):332-40.
  • Karataş M. Internuclear and Supranuclear Disorders of Eye Movement. Turk J Neurol. 2009;15(2):54.

SOL HEMİPLEJİ VE DİZARTRİ İLE BAŞVURAN MULTİPL SKLEROZ TANILI HASTADA AKUT İSKEMİK İNME

Year 2018, Volume: 20 Issue: 1, 97 - 100, 30.04.2018

Bahar Say Mehmet Tunç İlknur Yardımcı Murat Alpua Ufuk Ergün

https://doi.org/10.24938/kutfd.349222

Abstract



Multipl Sklerozda, santral sinir sistemindeki kronik
inflamasyonun indüklediği endotelial disfonksiyon ve buna bağlı ateroskleroz
serebrovasküler hastalık riskini artırır. Multipl Skleroz (sekonder progressif)
ve hipertansiyon (regüle) tanıları olup EDSS skoru 6 olan
54 yaşındaki bayan hasta intravenöz yüksek doz pulse steroid tedavisi sonrası
sol tarafında ani güç kaybı, konuşma ve yutma bozukluğu ile getirildi. Acil
servisteki difüzyon MR’da mezensefalon ile pons sağ kesiminde, serebellar
hemisferlerde difüzyon kısıtlaması gösteren akut enfarkt alanları izlendi. İnme
etiyolojisine yönelik yapılan karotis-vertebral doopler ultrasonografi ve transtorasik
ekokardiografi normaldi. Ritm holterde, aritmi izlenmedi. Rutin laboratuar
tetkikleri, tromboz ve vaskülit markerlerinde patoloji saptanmadı. Olguda inme
nedeni olarak Multipl Skleroz ve immobilite düşünüldü.



Multipl Skleroz hastalarında yeni gelişen nörolojik
disfonksiyon durumunda atak dışı neden, inme olasılığı da her zaman akılda
tutulmalıdır.

Keywords

Multipl Skleroz iskemik inme ateroskleroz

References

  • Kutzelnigg A, Lassmann H. Pathology of multiple sclerosis and related inflammatory demyelinating diseases. In: Goodin DS, eds. Handbook of Clinical Neurology. 3rd ed. China: Elsevier B.V. 2014:15-58.
  • Werner P, Pitt D, Raine CS. Multiple sclerosis: altered glutamate homeostasis in lesions correlates with oligodendrocyte and axonal damage. Ann Neurol. 2001;50(2):169-80.
  • Van Horssen J, Witte ME, Schreibelt G, de Vries HE. Radical changes in multiple sclerosis pathogenesis. Biochim Biophys Acta. 2011;1812(2):141-50.
  • Caprio MG, Russo C, Giugliano A, Ragucci M, Mancini M. Vascular Disease in Patients with Multiple Sclerosis. J Vasc Med Surg. 2016;4:259.
  • Ross R. Atherosclerosis-an inflammatory disease. N Engl Med J. 1999;340(2):115-26.
  • O’Keefe JH, Carter MD, Lavie CJ. Primary and secondary prevention of cardiovascular diseases: a practical evidence-based approach. Mayo Clin Proc. 2009;84:741-57.
  • Sevim S. Multipl Skleroz Atakları Üzerine Güncelleme: Tanım, Patofizyoloji, Özellikler, Taklitçiler ve Tedavi. Turk J Neurol. 2016;22:99-108.
  • Ranadive SM, Yan H, Weikert M, Lane AD, Linden MA, Baynard T, et al. Vascular dysfunction and physical activity in multiple sclerosis. Med Sci Sports Exerc. 2012; 44(2): 238-43.
  • Christiansen CF, Christiansen S, Mehnert F, Cummings SR, Chapurlat RD, Sørensen HT. Glucocorticoid use and risk of atrial fibrillation or flutter: a population-based, case-control study. Arc Intern Med. 2009;169(18):1677-83.
  • Kamışlı Ö, Tecellioğlu M, Özcan A. Sekiz buçuk Sendromu ile Karşımıza çıkan Multiple Skleroz Vakası. Kırıkkale Üniversitesi Tıp Fakültesi Dergisi. 2015;17(3):34-8.
  • Nerrant E, Tilikete C. Ocular Motor Manifestations of Multiple Sclerosis. J Neuroophthalmol. 2017;37(3):332-40.
  • Karataş M. Internuclear and Supranuclear Disorders of Eye Movement. Turk J Neurol. 2009;15(2):54.
There are 12 citations in total.

Details

Primary Language Turkish
Subjects Health Care Administration
Journal Section Case Reports
Authors

Bahar Say

Mehmet Tunç This is me

İlknur Yardımcı This is me

Murat Alpua

Ufuk Ergün

Publication Date April 30, 2018
Submission Date November 4, 2017
Published in Issue Year 2018 Volume: 20 Issue: 1

Cite

APA Say, B., Tunç, M., Yardımcı, İ., Alpua, M., et al. (2018). SOL HEMİPLEJİ VE DİZARTRİ İLE BAŞVURAN MULTİPL SKLEROZ TANILI HASTADA AKUT İSKEMİK İNME. Kırıkkale Üniversitesi Tıp Fakültesi Dergisi, 20(1), 97-100. https://doi.org/10.24938/kutfd.349222
AMA Say B, Tunç M, Yardımcı İ, Alpua M, Ergün U. SOL HEMİPLEJİ VE DİZARTRİ İLE BAŞVURAN MULTİPL SKLEROZ TANILI HASTADA AKUT İSKEMİK İNME. Kırıkkale Uni Med J. April 2018;20(1):97-100. doi:10.24938/kutfd.349222
Chicago Say, Bahar, Mehmet Tunç, İlknur Yardımcı, Murat Alpua, and Ufuk Ergün. “SOL HEMİPLEJİ VE DİZARTRİ İLE BAŞVURAN MULTİPL SKLEROZ TANILI HASTADA AKUT İSKEMİK İNME”. Kırıkkale Üniversitesi Tıp Fakültesi Dergisi 20, no. 1 (April 2018): 97-100. https://doi.org/10.24938/kutfd.349222.
EndNote Say B, Tunç M, Yardımcı İ, Alpua M, Ergün U (April 1, 2018) SOL HEMİPLEJİ VE DİZARTRİ İLE BAŞVURAN MULTİPL SKLEROZ TANILI HASTADA AKUT İSKEMİK İNME. Kırıkkale Üniversitesi Tıp Fakültesi Dergisi 20 1 97–100.
IEEE B. Say, M. Tunç, İ. Yardımcı, M. Alpua, and U. Ergün, “SOL HEMİPLEJİ VE DİZARTRİ İLE BAŞVURAN MULTİPL SKLEROZ TANILI HASTADA AKUT İSKEMİK İNME”, Kırıkkale Uni Med J, vol. 20, no. 1, pp. 97–100, 2018, doi: 10.24938/kutfd.349222.
ISNAD Say, Bahar et al. “SOL HEMİPLEJİ VE DİZARTRİ İLE BAŞVURAN MULTİPL SKLEROZ TANILI HASTADA AKUT İSKEMİK İNME”. Kırıkkale Üniversitesi Tıp Fakültesi Dergisi 20/1 (April 2018), 97-100. https://doi.org/10.24938/kutfd.349222.
JAMA Say B, Tunç M, Yardımcı İ, Alpua M, Ergün U. SOL HEMİPLEJİ VE DİZARTRİ İLE BAŞVURAN MULTİPL SKLEROZ TANILI HASTADA AKUT İSKEMİK İNME. Kırıkkale Uni Med J. 2018;20:97–100.
MLA Say, Bahar et al. “SOL HEMİPLEJİ VE DİZARTRİ İLE BAŞVURAN MULTİPL SKLEROZ TANILI HASTADA AKUT İSKEMİK İNME”. Kırıkkale Üniversitesi Tıp Fakültesi Dergisi, vol. 20, no. 1, 2018, pp. 97-100, doi:10.24938/kutfd.349222.
Vancouver Say B, Tunç M, Yardımcı İ, Alpua M, Ergün U. SOL HEMİPLEJİ VE DİZARTRİ İLE BAŞVURAN MULTİPL SKLEROZ TANILI HASTADA AKUT İSKEMİK İNME. Kırıkkale Uni Med J. 2018;20(1):97-100.
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