Pain as the presenting symptom of primary progressive multiple sclerosis
Zahoor S, Kaveeshvar H, Loomba V. Pain as the presenting symptom of primary progressive multiple sclerosis. Neurology 2016; 86(16).
Objective: To highlight a case in which a patient had extensive treatment for chronic pain but not sufficient diagnostic evaluation to determine the underlying cause of symptoms. Background: To our knowledge, this is the first case report of pain being the presenting symptom of primary progressive multiple sclerosis. Methods: Case Report Results: We present a case of a 32 year old female with a benign past medical history presenting for a multitude of chronic pain complaints and back pain. Prior to visiting our neurology clinic, patient had been to several different pain physicians and turned away due to suspicion of narcotic seeking behavior. She described her pain as being a constant throbbing and sharp bilateral pain. The pain started to effect her balance and her grip ability. She had followed with a pain physician who had prescribed her narcotics and various neuropathic pain medications which did not help as her condition worsened. When she finally arrived to neurology clinic she was noted to be hyper reflexic with diminished proprioception. An MRI cervical spine was performed which demonstrated multiple foci of increased T2 signal noted throughout the brain cervical cord, and thoracic cord, with suggestion of focal areas of cord atrophy, suggestive of demyelinating disease. CSF analysis was consistent with oligoclonal bands and IgG Index providing our patient with the likely diagnosis of primary progressive multiple sclerosis Conclusions: This case highlights the importance of taking a diagnostic approach to pain via a good neurologic exam. Our patient suffered through years of pain and increasing debility and finally coming to a diagnosis gave her a great sense of relief and prognostication.