Morquio Syndrome                              Orient Journal of Medicine                              Vol 31 [1-2] Jan-June, 2019
CASE REPORT

Dominant Hemisphere and Upper Cervical Cord Tumefactive Multiple Sclerosis in a Nigerian Teenager Initially Misdiagnosed and Managed

Chika A NDUBUISI
Kelechi O NDUKUBA
Okwunodulu O OKWUOMA
Linda U IROEGBU
Samuel C OHAEGBULAM


Department of Neurosurgery Memfys Hospital for Neurosurgery, Enugu Enugu State, NIGERIA


Author for Correspondence
Dr Chika A NDUBUISI
Memfys Hospital for Neurosurgery P.O.Box 2292 Enugu, NIGERIA


Phone: +2348034360540
E-mail: chikandu@yahoo.com



Received: September1st, 2018
Accepted: January I1th, 2019


DISCLOSURE Memfys Hospital for Neurosurgery’s Management gave waiver for the follow-up MRI.
A portion of this work was presented at the WFNS meeting (Istanbul 2017)

ABSTRACT

A 13-year old right handed Nigerian girl presented with eleven weeks history of progressive visual loss, three weeks right hemi-body weakness which progressed to quadriparesis, dysphasia, severe headache, tonic-clonic seizures, neck pain, vomiting and fever. Examination revealed Glasgow Coma Score (E4M6V2), expressive dysphasia and depressed mood. Visual Acuity was counting finger bilaterally. Neck was supple. She had global hypotonia, grade 3 hyper-reflexia and extensor Babinski bilaterally. Power was 0/5 in the right upper limb and right lower limb, 2/5 in the left lower limb and 4/5 in the left upper limb. Other examinations were unremarkable. Contrast enhanced brain MRI revealed three cystic ring enhancing masses at left fronto-parieto-occipital region, associated oedema, midline shift and C2-C4 intramedullary mass with cord oedema. The ring enhancement was incomplete towards the cortex. Following initial suspicions of cystic brain tumour with spinal cord metastasis, she had decompression biopsy. Histology was inflammatory lesion, clinically assumed to be from brain abscess. Failure of antibiotic treatment and the deteriorating neurology prompted mini-craniectomy and biopsy of the cyst wall. Final diagnosis was tumefactive multiple sclerosis. She was successfully managed with methylprednisolone. Follow-up clinical condition has been satisfactory.



Keywords: TMS, cranial masses, multiple sclerosis, visual loss