Abstrakt

This clinical case describes an aphasia after the vaginal delivery at 39 years old primigravida in term as a first manifestation of multiple sclerosis. Early postpartum episode was complicated by hypotonia and anemia.

On the third day patient presented herself with anxiosity, dysphasia and instability. The working diagnose was ischemic stroke of unknown length and computerized tomography (CT) was done. During the afternoon patient presented with transitory mydriasis on left eye and her status deteriorated to severe dysphasia/aphasia and enhanced reflexes on the right side. Despide CT not displaying any changes (bleeding), nor occlusions, the conclusion of neurologist remained cerebral ischemia. Results were consulted with tertiary center and conservative treatment was recommended.

Next day due to aphasia magnetic resonance imaging (MRI) was done. MRI displayed multiple hypersignal focuses in the white matter around lateral ventricles and corpus callosum in T2 and FLAIR (FLuid Attenuated Inversion Recovery) sequences.

This suggested primary manifestation of multiple sclerosis and lumbar punction was done. A therapy with methylprednisolone was started immediately. The punctate displayed elevation of cytokines in liquor and serum. In liquor dominated elevation of interleukine-8 and interleukine-6 with no specific agent isolated.

This clinical case displays the deceptiveness of multiple sclerosis which can demonstrate itself like cerebral stroke. The manifestation of multiple sclerosis mimicking stroke is a rare condition that occurs in about 2% and acute aphasia is even rarer.

To our knowledge this is the first report about acute aphasia mimicking stroke as a first manifestation of the multiple sclerosis.