engleski

Sudden onset aphasic hemiplegia: An unusual manifestation of disseminated encephalomyelitis

The association of the sudden onset aphasia with hemiplegia, hemisensory defect, and facial palsy, with MRI evidence of white matter lesions, requires differentiation between multiple sclerosis (MS) and acute disseminated encephalomyelitis (ADEM). We have observed eight patients with such a syndrome, all of whom were originally diagnosed as multiple sclerosis, but who, on closer examination, turned out to be instances of disseminated encephalomyelitis (DEM). The patterns of demyelination seen in T2-weighted MRI are quite different in both conditions. In our eight cases there were large areas of increased signal intensity (AISI) on T2-weighted MRI, which are characteristic of DEM. In two of our patients MRI reverted to normal after the treatment ; in others, the images remained unchanged. In most patients who are aphasic as a result of MS or DEM, the AISIs involve the subcortical white matter. Explanation for this could be based on the concept of diaschisis. According to this concept, impaired function occurs in one area secondary to an acute focal lesion in a more distant part of the brain ; thus, lesions of white matter tracts that are anatomically connected to the cortical language centers produce aphasias or similar speech difficulties which are undistinguishable from those of cortical origin. A review of the reported cases of multiple sclerosis presenting with the acute onset of aphasia reveals that the majority of them are, in reality, instances of ADEM with a much better prognosis. Most of these cases are monophasic and immunomodulatory treatment is inappropriate.

aphasic hemiplegia; acute disseminated encephalomyelitis; multiple sclerosis; MRI

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