A case of multiple sclerosis associated with early onset parkinsonism

Background: The association of MS and parkinsonism is still a controversial topic because it has not been yet established whether these two conditions occur coincidentally or causally. Case report: We report a 53 year-old woman with an insidious onset of extrapyramidal syndrome. Brain magnetic resonance imaging (MRI) scan revealed multiple hyperintense T2-weighted lesions in the white matter and no lesions in the basal ganglia or midbrain. DaT-SCAN showed reduced level of dopamine carrying protein on right side. Treatment with levodopa induced a marked improvement. Seven years later she developed a myelitis. Spinal cord MRI detected two hyperintense lesions at cervical and dorsal levels. Complete blood count, biochemical profile and coagulation were normal as well as autoimmunity screening. Cerebrospinal fluid (CSF) analysis showed intrathecal synthesis with oligoclonal bands. The patient received intravenous methylprednisolone with marked improvement. A new MRI scan shows a new paraventricular hyperintense T2 weighted lesion. Conclusion: There are some case reports describing patients with parkinsonism and MS demyelinating lesions. Two hypotheses might account for this association. The first one is the coincidental occurrence of Parkinson's disease in MS patients. The second hypothesis postulates that parkinsonism is due to MS itself as a secondary manifestation of immune and neurodegenerative damages affecting dopaminergic pathways. (C) 2013 Elsevier GmbH. All rights reserved.