CENTRAL MYELIN AND DEMYELINATION

Abstract

INTRODUCTION:CNS demyelinating disorders are common neurological illness that affects the brain. This causes signi\uf001cant disability and\nmortality if not properly identi\uf001ed and treated. CNS demyelinating diseases includes multiple sclerosis, acute disseminated encephalomyelitis,\nNMO spectrum disorders and transverse myelits. Here we are reporting a case of central demyelination.\nCASE SUMMARY: 44yrs female admitted with subacute onset of weakness of all four limbs, more on left side and sensory disturbance in the\nform of numbness and tingling in all four limbs, more on left side, associated with urinary urgency and constipation. Patient had right optic neuritis\n3 years back. General examination was normal. Vital signs were stable.\nOn nervous system examination, patient had decresed visual acuity in right eye, with relative afferent pupillary defect and impaired red green\ncolour vision, fundus was normal. Motor system examination, Patient had normal bulk, increased tone, brisk deep tendon re\uf002exes, power of 4 on\nright and 4- on left side with extensor planter on both sides. Patient had decresed sensation below C5 spinal cord level, predominantly joint position\nand vibration sense with positive lhermitte s sign. Other systems were normal. Routine lab investigation ,ECG,CXR were normal. CSF analysis\nrevealed elevated protein of 72mg.\nMRI BRAIN WITH WHOLE SPINE SCREENING(contrast) revealed Multiple smallT2/FLAIR hyperintense lesion in bilateral juxta cortical,\nsubcortical(involving the temporal lobes and callososeptal interface), subtle patchy enhancement in the left peritrigonal lesion and in body of\ncorpus callosum. Mild atrophy of cervical cord from C3 to C5 with T2 hyperintense involving both hemicord from C2 to C5 level, focal\nHyperintensity subtle contrast enhancement in Dorsal cord at the level of D11, Features suggestive of demyelination likely Multiple Sclerosis.