Stroke-like course of multiple sclerosis with the very late onset

Stwardnienie rozsiane jest chorobą dotykającą głównie młodych dorosłych, a w powszechnie przyjętych kryteriach diagnostycznych określono wiek 59 lat jako górną granicę dla pierwszorazowych zachorowań. Jednak pierwsze objawy tego schorzenia mogą się pojawić po 60, 70, a nawet po 80 roku życia. Opisany przez autorów przypadek dotyczy 63-letniego pacjenta, u którego choroba rozpoczęła się nagle, wśród pełnego zdrowia. Stwierdzane objawy (ośrodkowy niedowład mięśni twarzy i niedowład połowiczy) świadczyły o półkulowej lokalizacji ogniska uszkodzenia, co u chorego w starszym wieku sugerowało etiologię udarową. Tomografia komputerowa mózgu wykazała zmianę hipodensyjną w sąsiedztwie rogu czołowego lewej komory bocznej, mogącą odpowiadać ognisku niedokrwiennemu. Ponieważ w ciągu kilku dni wystąpiły nowe objawy neurologiczne, zdecydowano o wykonaniu badania mózgowia metodą rezonansu magnetycznego, które w istocie białej obu półkul uwidoczniło okołokomorowo liczne ogniska hiperintensywne w fazie T2. Pozwoliło to zweryfikować rozpoznanie. Zastosowane u chorego leczenie steroidami szybko spowodowało poprawę neurologiczną. Opisany przez autorów przypadek dowodzi, że chociaż stwardnienie rozsiane po 60 roku życia rozpoczyna się rzadko, należy brać je pod uwagę po wykluczeniu innych, typowych dla tego wieku schorzeń. Dodatkową trudność diagnostyczną stwarza fakt, że może ono przebiegać nietypowo, sugerując znacznie częstszy w tej grupie wiekowej udar mózgu.Multiple sclerosis (MS) is a demyelinating disease of the central nervous system mostly affecting young alults. Well-accepted diagnostic criteria suggest 59 years as the upper limit of age at onset. For this reason a diagnosis of MS in older individuals is frequently not taken into consideration. Nevertheless, the initial symptoms of the disease may appear, though rarely, after the age of 60, 70 or even 80 years. We present a case history of a patient with a very late onset of MS. A previously healthy, 63-year-old man was addmitted to the hospital due to sudden weakness of his right limbs. A detailed interview has not revealed any kind of neurologic dysfunction before the actual attack. Central paresis of the face muscles, and slight spastic weakness of the right limbs suggested the left hemisphere localization of the lesion. Taking into consideration the advanced age of a patient, the initial diagnosis of stroke was established. Computed tomography scan revealed a hypodense lesion near the frontal cornu of the left lateral ventricle of probable ischaemic origin. During a few days of hospitalization a neurological condition of a patient got worse. The right limbs paresis intensified into paralysis and deep sensation deficits in the left limbs appeared. Magnetic resonance imaging showed many periventricular lesions within the white matter of both hemispheres, which were hyperintense on T2-weighted images. According to these observations a diagnosis of stroke had to be changed into MS. Due to the treatment with intravenous steroids an appreciable improvement of patient’s condition was reached. Diagnostic difficulties described in our case report were associated with the following conditions: 1) a very late onset and untypical course of the disease (the clincal course of MS in patients after 60 years at onset tends to be slowly progressive from the beginning rather than relapsing - remitting); 2) site of clinical involvement (in MS of late onset predominant involvement affects spinal cord. Cerebral involvement with acute motor funcion deterioration is extremely rare). Our case report shows that MS should not be considered as diagnosis of exclusion in patients after age 60. Moreover, the course of MS may imitate stroke, much more common at this period of life

Predyktory objawów depresyjnych u pacjentów po udarze mózgu : obserwacja trzymiesięczna

Background and purpose Depression is one of the most common post-stroke complications, which could impair rehabilitation outcome and quality of life, and could also increase mortality after stroke. The aim of the present study was to assess the association between demographic, socioeconomic and clinical (stroke risk factors, type of stroke, location of vascular lesion, cognitive functions) factors on the presence and severity of post-stroke depressive symptoms in patients after first ever stroke as well as on their social functioning. Material and methods A prospective, cohort study with a three-month observation period was performed in seven centres. Severity of depressive symptoms was assessed with the help of a short, 15-item version of the Geriatric Depression Scale (GDS), 3 months after stroke onset. Results On the basis of GDS (GDS ≤ 5 points or > 5 points) patients were allocated to a group without (n = 160) or with symptoms suggestive of depression (n = 82). The study groups did not differ with respect to age, sex or place of residence. Univariate logistic regression analysis showed that independent predictors for the presence of symptoms suggestive of depression at 3 months after stroke were: low level of education, low income, greater severity of stroke, worse functional status, self-reported problems with daily-living activities and need of help in daily living activities. More than 60% of patients with depressive symptoms limited their social contacts. Patients with depressive symptoms were unsatisfied with their relations with life partners and friends. Conclusions Our study showed a complex aetiology of post-stroke depressive symptoms with an important role of socioeconomic factors. Depressive symptoms after stroke worsen existing health, social and economic problems, and cause social isolation of patients