Isolated trigeminal nerve palsy with motor involvement as a presenting manifestation of multiple sclerosis in an equatorial region – a case report

Abstract

IntroductionIsolated cranial nerve palsies are considered to be an uncommon presenting feature of multiple sclerosis. Involvement of the trigeminal nerve, particularly its motor component as part of a clinically isolated syndrome of multiple sclerosis has rarely been reported in equatorial regions and no cases have been described in Sri Lanka thus far.Case PresentationWe report a case of isolated right sided trigeminal nerve palsy (Motor and Sensory) in a 34 year old previously well lady from urban Sri Lanka who was found to have characteristic lesions on Magnetic Resonance Imaging highly suggestive of multiple sclerosis.ConclusionsMultiple sclerosis should be considered in the differential diagnosis of patients who present with isolated cranial nerve palsies. Clinicians should have a high index of suspicion when evaluating such patients especially in low prevalence regions close to the equator. Early recognition and treatment of such a “Clinically Isolated Syndrome” may prevent early relapse.

Unusual primary manifestations of multiple sclerosis: A case report

“…Although some report that brain stem demyelination is one mechanism, isolated cranial nerve palsy is insufficient to explain MS pathogenesis [3]. Recently, the first clinical picture of recurrent MS has been described as "clinical isolated syndrome" (CIS) [4]. Therefore, isolated cranial nerve palsy with characteristic imaging patterns is now in this category.…”

A Case of Multiple Sclerosis Presented with 5th, 6th and 7th Cranial Nerve Paralysis

“…2 Retrobulber nörit, serebellar sendromlar, transvers myelit gibi birçok değişik tablo ile karşımıza gelebilir. 3 Beyin sapı tutulumu MS hastalarında sık görülse de başka semptom olmaksızın izole kraniyal sinir tutulumu oldukça nadirdir. 1 Birçok çalışmada MS hastalarında en sık görülen kraniyal sinir tutulumunun trigeminal sinir olduğu gösterilmiştir.…”

“…1 Birçok çalışmada MS hastalarında en sık görülen kraniyal sinir tutulumunun trigeminal sinir olduğu gösterilmiştir. 3 Bunu sırasıyla fasiyal, abdusens, okulomotor ve kohlear sinir tutulumları takip etmektedir. 1 Bu olgu sunumunda, eş zamanlı 5., 6. ve 7. sinir tutulumu ile başvuran ve MS tanısı alan klinikte nadir gözlemlediğimiz bir olgu tartışılacaktır.…”

Motor development of infants exposed to maternal human immunodeficiency virus (HIV) but not infected

“…Motor development has been discussed and more intensively investigated recently [1-3]. Theories try to explain whether the main influence on its progress is the biological maturation or the environmental experience [4], taking into account the importance of the initial bond of the infant with the reference carer [5], and the factors that may cause cultural and clinical interference [6-9].…”