Paroxysmal dysarthria and other transient neurological disturbances in disseminated sclerosis.

Transient neurological disturbances are not infrequently encountered in multiple sclerosis (MS) and may be precipitated by such factors as exercise, hot baths, smoking and emotion,' neck flexion2 and eye movements.3 It is also of interest that many of the familiar manifestations of MS which typically have a duration of weeks or months may also occur in the form of shortlived repetitive paroxysms. The nature of the paroxysmal symptoms depends on their site of origin, which is usually in the brain stem or spinal cord. The main types that have been reported are tonic seizures, paroxysmal dysarthria and ataxia, paroxysmal paraesthesiae and pains including trigeminal neuralgia, and paroxysmal akinesia. These may be distinguished firstly by their brevity, lasting usually for just a few seconds to one to two minutes, and secondly by recurring in a stereotyped fashion from a few times a day to several times an hour. Most come on spontaneously, but some are triggered by hyperventilation, anxiety, muscular activity and tactile stimuli. They continue to recur in this way for a few days, weeks or months whereupon remission ensues, but the response to treatment with carbamazepine is often dramatic.

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“…Four patients (1,8,9 and 10) had clinically definite MS, four (11)(12)(13)(14) latent MS and the remaining six (2-7) suspected MS, according to …”

Section: Patientsmentioning

confidence: 99%

Paroxysmal symptoms as the first manifestations of multiple sclerosis.

Twomey¹,

Espir²

1980

Journal of Neurology, Neurosurgery & Psychiatry

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100

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“…15 These phenomena have been attributed to intermittent cerebral ischemia due to carotid occlusive disease. To our knowledge, there have been no prior reports of involuntary movements due to a lacunar infarct that does not involve the basal ganglia or subthalamic nucleus.…”

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confidence: 99%

Involuntary tonic spasms of a limb due to a brain stem lacunar infarction.

Kaufman

Brown

Karnes

1994

Stroke

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Background and Purpose Although repetitive involuntary movements are a well-recognized manifestation of carotid occlusive disease, similar movements have not been reported with a lacunar infarction outside of the basal ganglia or subthalamic nucleus. We describe a man with tonic spasms associated with a lacunar infarction in the right ventral pons.Case Description Involuntary tonic spasms of a paretic limb developed acutely in a 69-year-old hypertensive man with a clinical presentation of pure motor hemiparesis. Magnetic resonance imaging demonstrated a lacunar infarction of the

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“…This is recognized in paroxysmal events when they are the presenting feature of multiple sclerosis; reported remissions, before other manifestations of MS develop, range from less than one year to 21 years (Twomey & Espir, 1980). The character of the brain stem paroxysmal attacks in a young woman, favourable response to carbamazepine (Espir & Millac, 1970), and the isolated short episode of ataxia are evidence that the underlying pathology is demyelinating in this case. The abnormal brain stem evoked responses (Chiappa et al, 1980), and the increased cerebrospinal fluid immunoglobulin are also significantly supportive to the diagnosis of demyelination in our patient.…”

Section: Discussionmentioning

confidence: 63%

“…Intermittent conduction block (Espir et al, 1966), or transversely spreading ephaptic activation of axons (Osterman & Westerberge, 1975), in partially demyelinated lesions within the brain stem are mechanisms invoked to explain these phenomena. Both ocular flutter and transient ataxia may result from a lesion in the region of the cerebellar peduncles (Goldberg & Jampel, 1963;Osterman & Westerberge, 1975).…”

Section: Discussionmentioning

confidence: 99%