Case report: MS masquerading as Parkinson’s Disease

Damásio et al. A coincidental case of young-onset Parkinson disease and multiple sclerosis. Neurologist. 2011 Sep;17(5):286-8.

Background: Parkinsonism in patients with multiple sclerosis is rare. Some patients have 2 coincidental diseases, whereas others have a Parkinsonian syndrome symptomatic to demyelinating lesions.

“Parkinsonism refers to the clinical signs that are found in patients with Parkinson’s disease; these included rigidity of their limbs, slowness of movement, tremor (which is typically occurs at rest and is described as pill-rolling) and postural instability (poor balance with a tendency to fall when pushed).”

Case report: They describe a 42-year-old female patient who developed a left sided Parkinsonian syndrome at the age of 38 years. Brain MRI revealed multiple white matter lesions compatible with demyelinating disease. A diagnostic scan for Parkinson’s disease, a DAT scan, was abnormal. A course of steroids were unhelpful. She had major clinical improvement with the drug L-Dopa that is used for treating Parkinson’s disease. At the age of 41 years, she presented with a brainstem attack, with complete symptom resolution after intravenous corticosteroids. Subsequent MRI disclosed new inflammatory lesions consistent with MS. Immunomodulatory treatment was started with β-interferon.
Comments: In this patient, the presence of an asymmetrical Parkinsonian syndrome, with good response to L-Dopa, and an abnormal DAT scan, supports the diagnosis of young-onset Parkinson disease. The MS diagnosis was established based on clinical evidence of dissemination in time and space.
“The Parkinsonism in this MS’er was almost certainly due to gray matter disease in the area of the brain called the basal ganglia.”

“How rare is this? I have been working in the field of MS since 1993 and in that time I have seen two MS’ers with Parkinsonism. I would therefore say it is pretty rare.” 

“The message from this case report is that MS can have many different presentations and that clinicians have to be aware of these atypical presentations. This is very important so that patients are given the correct treatment and counselling.”

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