Multiple Sclerosis: two clinical presentations, a single disease!

Authors

  • Ana Margarida Ferreira da Silva Unidade de Saúde Familiar das Ondas, Aces Porto IV. Póvoa de Varzim, Vila do Conde
  • Francisco Pinto da Costa Unidade de Saúde Familiar das Ondas, Aces Porto IV. Póvoa de Varzim, Vila do Conde
  • Miguel Baptista Hospital Pedro Hispano. Unidade Local de Saúde Matosinhos
  • Teresa Febra Unidade de Saúde Familiar das Ondas, Aces Porto IV. Póvoa de Varzim, Vila do Conde
  • Carla Morna Unidade de Saúde Familiar das Ondas, Aces Porto IV. Póvoa de Varzim, Vila do Conde

DOI:

https://doi.org/10.5712/rbmfc9(33)753

Keywords:

Multiple Sclerosis, Central Nervous System, Paresthesia, Optic Neuritis, Primary Health Care

Abstract

Objective: this case report aims to demonstrate the diversity of clinical presentations, the symptoms evolution and the role of the primary care physician in the diagnosis and management of patients with multiple sclerosis, and their families. Case descriptions: two women, 31 and 28 years old, Caucasian, inserted within nuclear families (phases II and IV of the Duvall’ cycle, respectively) belonging to the middle class of Graffar. The first one starts an insidious symptom of paraesthesia of the hands with improvement in 2 months. Within a year, she presents with difficulty raising the eyelids and marked imbalance. The second one presents sudden loss of visual acuity on the right, having been diagnosed with optic neuritis. Both were diagnosed with multiple sclerosis. Conclusion: multiple sclerosis is a chronic inflammatory, degenerative and demyelinating disease of the central nervous system that manifests heterogeneously. It is important for the family doctor to know how to deal with diagnostic uncertainties.

Downloads

Download data is not yet available.

Metrics

Metrics Loading ...

Author Biographies

Ana Margarida Ferreira da Silva, Unidade de Saúde Familiar das Ondas, Aces Porto IV. Póvoa de Varzim, Vila do Conde

Interna de Formação Espacífica de Medicina Geral e Familiar, Unidade de Saúde Familiar das Ondas, Agrupamento de Centros de Saúde Grande Porto IV - Póvoa de Varzim - Vila do Conde

Francisco Pinto da Costa, Unidade de Saúde Familiar das Ondas, Aces Porto IV. Póvoa de Varzim, Vila do Conde

Interno de Formação Espacífica de Medicina Geral e Familiar, Unidade de Saúde Familiar das Ondas, Agrupamento de Centros de Saúde Grande Porto IV - Póvoa de Varzim - Vila do Conde

Miguel Baptista, Hospital Pedro Hispano. Unidade Local de Saúde Matosinhos

Interno de Neurorradiologia, Hospital Pedro Hispano, ULS Matosinhos

Teresa Febra, Unidade de Saúde Familiar das Ondas, Aces Porto IV. Póvoa de Varzim, Vila do Conde

Especialista de Medicina Geral e Familiar, Unidade de Saúde Familiar das Ondas, Agrupamento de Centros de Saúde Grande Porto IV - Póvoa de Varzim - Vila do Conde

Carla Morna, Unidade de Saúde Familiar das Ondas, Aces Porto IV. Póvoa de Varzim, Vila do Conde

Especialista de Medicina Geral e Familiar, Unidade de Saúde Familiar das Ondas, Agrupamento de Centros de Saúde Grande Porto IV - Póvoa de Varzim - Vila do Conde

References

Calabresi PA. Diagnosis and management of multiple sclerosis. Am Fam Physician. 2004 Nov 15;70(10):1935-44.

World Health Organization. Multiple Sclerosis International Federation. Atlas: Multiple sclerosis resources in the world 2008. Geneva, Switzerland: World Health Organization; 2008.

Polman CH, Reingold SC, Banwell B, Clanet M, Cohen JA, Filippi M, et al. Diagnostic criteria for multiple sclerosis: 2010 revisions to the McDonald criteria. Ann Neurol. 2011 Feb;69(2):292-302. Disponível em: http://dx.doi.org/10.1002/ana.22366 DOI: https://doi.org/10.1002/ana.22366

Paty DW, Oger JJ, Kastrukoff LF, Hashimoto SA, Hooge JP, Eisen AA, et al. MRI in the diagnosis of MS: a prospective study with comparison of clinical evaluation, evoked potentials, oligoclonal banding and CT. Neurology. 1988;38:180-5. Disponível em: http://dx.doi.org/10.1212/WNL.38.2.180 DOI: https://doi.org/10.1212/WNL.38.2.180

Tintoré M, Rovira A, Martínez MJ, Rio J, Díaz-Villoslada P, Brieva L, et al. Isolated demyelinating syndromes: comparison of different MR imaging criteria to predict conversion to clinically definite multiple sclerosis. Am J Neuroradiol 2000;21:702-6.

McDonald WI, Compston A, Edan G, Goodkin D, Hartung HP, Lublin FD, et al. Recommended diagnostic criteria for multiple sclerosis: guidelines from the International Panel on the diagnosis of multiple sclerosis. Ann Neurol. 2001;50:121-7. Disponível em: http://dx.doi.org/10.1002/ana.1032 DOI: https://doi.org/10.1002/ana.1032

Polman CH, Reingold SC, Edan G, Filippi M, Hartung HP, Kappos L, et al. Diagnostic criteria for multiple sclerosis: 2005 revisions to the ‘‘McDonald Criteria”. Ann Neurol. 2005;58:840–6. Disponível em: http://dx.doi.org/10.1002/ana.20703 DOI: https://doi.org/10.1002/ana.20703

Coyle PK, Hartung HP. Use of interferon beta in multiple sclerosis: rationale for early treatment and evidence for dose- and frequency-dependent effects on clinical response. Mult Scler. 2002;8(Suppl 1):2-9. Disponível em: http://dx.doi.org/10.1177/135245850200800102. DOI: https://doi.org/10.1177/135245850200800102

Trapp BD, Peterson J, Ransohoff RM, Rudick R, Mork S, Bo L. Axonal transection in the lesions of multiple sclerosis. N Engl J Med. 1998;338:278-85. Disponível em: http://dx.doi.org/10.1056/NEJM199801293380502. DOI: https://doi.org/10.1056/NEJM199801293380502

Jacobs LD, Beck RW, Simon JH, Kinkel RP, Brownsheidle CM, Murray TJ, et al. Intramuscular interferon beta-1a therapy initiated during a first demyelinating event in multiple sclerosis. CHAMPS Study Group. N Engl J Med. 2000 Sep;343:898-904. Disponível em: http://dx.doi.org/10.1056/NEJM200009283431301. DOI: https://doi.org/10.1056/NEJM200009283431301

Comi G, Filippi M, Barkhof F, Durelli L, Edan G, Fernandex O et al. Effect of early interferon treatment on conversion to definite multiple sclerosis: a randomised study. Lancet 2001; 357: 1576-82. Disponível em: http://dx.doi.org/10.1016/S0140-6736(00)04725-5. DOI: https://doi.org/10.1016/S0140-6736(00)04725-5

Published

2014-09-11

How to Cite

1.
Silva AMF da, Costa FP da, Baptista M, Febra T, Morna C. Multiple Sclerosis: two clinical presentations, a single disease!. Rev Bras Med Fam Comunidade [Internet]. 2014 Sep. 11 [cited 2024 Jul. 3];9(33):365-70. Available from: https://rbmfc.org.br/rbmfc/article/view/753

Issue

Section

Clinical Cases

Plaudit