engleski

Schider's type of multiple sclerosis in a mid-aged woman

Introduction. Schilder's Type of myelinoclastic sclerosis is rare variant of multiple sclerosis in children and young adults. Usually, brain lesion occur in the white matter like solitary, or less often more, acute plaques ranged in diameter more then 3 cm. Clinical details. The 49 year female patient was referred to our hospital with progressive right-sided hemiparesis, motor dysphasia and frontal lobe syndrome. Symptoms started 14 days earlier with acute headache and no febrile state was reported. MRI of the head revealed two oval lesions with hyperintensity in T2 weighted images of left frontal and parietal lobe. The first diagnostic impression was of glioblastoma multiforme. Results from standard blood and urine tests, tumor markers and cytological analysis of bone marrow were normal. Analysis of CSF and culturing CSF and serum for bacterial, viral, protozoan and fungal infections were negative. Analysis of CSF revealed increased immunoglobulins, 3OCB and increased intratecal synthesis of IgG. A stereotactic biopsy was performed one month after first symptoms. Neuropathology findings. The biopsy after neurosurgical treatment yielded five needle cores of grayish cerebral tissue. Hematoxylin and eosin-stained sections of paraffin embedded tissue showed demyelinating white cerebral tissue with relatively sharply defined margins. Lesion was infiltrated by macrophages (CD68 immunopositive cells and Luxol fast blue negative) and large reactive astrocytes with Ki67 and PCNA nuclear positivity. Around blood vessels were scattered perivascular CD4 and CD20 lymphocyte. Silver impregnation and NF immunostaining showed that the axons within the plaque are attenuated but not destroyed. Conclusion. Clinical and pathological findings suggested a demyelinating disease destroyed huge parts of white matter in before health mid-aged women, without further infection or vaccination. Accordingly we diagnosed Schilder's type of MS.

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