Acute Spinal Cord Syndrome As the Initial Manifestation of Multiple Sclerosis - A Case Report

Sep 29, 2026

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Multiple sclerosis (MS) usually begins with optic neuritis, brainstem syndromes, or sensory disturbances, while isolated spinal cord involvement as the first manifestation occurs in fewer than 30% of cases. Early recognition is therefore difficult yet critical for timely diagnosis and treatment. A previously healthy 22-year-old man developed acute mid-thoracic pain, progressive sensory loss below T10, and paraparesis. Spinal MRI showed gadolinium-enhancing intramedullary lesions, brain MRI showed demyelination, and CSF confirmed oligoclonal bands. High-dose intravenous methylprednisolone led to significant improvement.

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CategoryHealthcare

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Abstract

Introduction

Case Presentation

Review began 11/06/2025 Review ended 11/26/2025 Published 12/07/2025 © Copyright 2025 Pinto Silva et al. This is an open access article distributed under the terms of the Creative Commons Attribution License CCBY 4.0. , which permits unrestricted use , distribution , and reproduction in any medium , provided the original author and source are credited. DOI: 10.7759/cureus.98644 Open Access Case Report Acute Spinal Cord Syndrome As the Initial Manifestation of Multiple Sclerosis: A Case Report Catarina Pinto Silva 1 , Cristiana Fernandes 1, Márcia Ribeiro 1, Dany Cruz 1 1. Internal Medicine, Hospital Santa Maria Maior, Barcelos, PRT Corresponding author: Catarina Pinto Silva, [catarina0894@gmail.com](catarina0894@gmail.com) Abstract Multiple sclerosis (MS) typically presents with optic neuritis, brainstem syndromes, or sensory disturbances. Isolated spinal cord involvement as the initial manifestation occurs in fewer than 30% of cases, making early recognition challenging but essential for timely diagnosis and treatment initiation. A previously healthy 22-year-old Caucasian male presented with an acute onset of mid-thoracic pain followed by progressive sensory deficits below the T10 dermatome and lower limb weakness developing over five days. Neurological examination revealed spastic paraparesis (Medical Research Council grade 3/5), sensory level at T10, and hyperreflexia with bilateral Babinski signs. Magnetic resonance imaging (MRI) of the spinal cord demonstrated two focal T2-hyperintense intramedullary lesions at T1-T2 and T 11 levels with gadolinium enhancement. Brain MRI revealed a single periventricular lesion consistent with demyelination. Cerebrospinal fluid analysis showed lymphocytic pleocytosis (11 cells/µL), mildly elevated protein (52 mg/dL), and two oligoclonal bands restricted to cerebrospinal fluid (CSF) . The patient received high-dose intravenous methylprednisolone (1 g daily for three days) with significant neurological improvement. At the three-month follow-up, motor strength had improved to grade 4/5 with residual mild sensory deficits. This case illustrates the diagnostic challenges of MS presenting as isolated spinal cord syndrome. Early spinal MRI and CSF analysis are crucial for accurate diagnosis and prompt therapeutic intervention, potentially improving long-term outcomes. Categories: Neurology, Integrative/Complementary Medicine, Internal Medicine Keywords: demyelinating disease, multiple sclerosis, oligoclonal bands, spinal cord syndrome, transverse myelitis Introduction Multiple sclerosis (MS) is a chronic, immune-mediated demyelinating disorder of the central nervous system (CNS) and a leading cause of neurological disability in young adults. According to the most recent Atlas of MS, approximately 2.8 million people are affected worldwide [1] . Typical initial manifestations include optic neuritis, brainstem syndromes, and sensory disturbances [2,3] . Spinal cord involvement may occur in up to one-third of first presentations but is less frequently isolated, making early diagnosis more challenging [4] . Spinal cord lesions in MS typically appear as short, ovoid, and peripherally located, most often involving less than two vertebral segments [5] . Under the 2017 revision of the McDonald criteria, demonstrating dissemination in space across the brain and spinal cord is essential for diagnosis [6] . Early recognition of spinal cord presentations is critical, as lesion burden strongly correlates with long-term disability and risk of conversion to secondary progressive MS [7,8] . According to the 2017 revision of the McDonald criteria, MS may be diagnosed after a first clinical event when dissemination in space (lesions in at least two typical CNS regions, such as the brain and spinal cord) and dissemination in time (simultaneous presence of enhancing and non-enhancing lesions or cerebrospinal fluid (CSF)-specific oligoclonal bands) are demonstrated [6] . Howe

FAQs

Why is isolated spinal cord involvement difficult to recognize in multiple sclerosis?

Isolated spinal cord involvement as the initial manifestation occurs in fewer than 30% of cases, so it is less common and more challenging to diagnose early.

What findings supported multiple sclerosis in this case?

Spinal MRI showed gadolinium-enhancing intramedullary lesions, brain MRI revealed a periventricular demyelinating lesion, and cerebrospinal fluid demonstrated lymphocytic pleocytosis with CSF-restricted oligoclonal bands.

How was the patient treated and what was the outcome?

He received high-dose intravenous methylprednisolone (1 g daily for three days), resulting in significant neurological improvement, with improved motor strength at follow-up and residual mild sensory deficits.

Sep 29, 2026

Upload by jayni