Shiraz E-Medical Journal
Multiple Sclerosis (MS) can presents with a wide variety of clinical manifestations. Because of diversity of symptoms and signs, physicians must be careful in attributing non- typical neurological manifestation to psychiatric disorders.
A 40 years old male patient referred to our clinic with history of gradual onset of left sided visual loss;and paresthesia and numbness on left side of the face and body. He was seen by many neurologists and psychiatrists and was treated with diagnosis of conversion reaction. Neurological examination was normal except for subjective sensory loss. Visual acuity was normal on both eyes. Marcus Gunn sign was negative. Brain Magnetic Resonance Imaging (MRI), Visual Evoked Potentials (VEP), and lumbar puncture confirmed diagnosis of multiple sclerosis.
Multiple sclerosis may present with atypical symptoms and signs and no objective data may be found in neurological examination. Confusion with psychiatric problems has been mentioned in the literature . Physicians must be careful in attributing such symptoms to psychiatric disorders . Above mentioned case is a notable example of such a problem. He presented with simultaneous onset of loss of vision and hemi sensory loss on the same side, which is an anatomical impossibility from a single lesion and mentioned in neurological textbooks a sign of conversion reaction .Also no objective sign was found in neurological examination (negative Marcus Gunn sign and similar visual acuity in both eyes ). Key point that resulted in correct diagnosis was careful sensory examination that revealed organic type of sensory loss (area of sensory loss was lesser than half of the face and body, and shift from painless to pain full area was Para sagittal and not in the midline). We concluded that atypical symptoms and signs must not automatically attribute to conversion reaction and accurate neurological examination is the best way of making correct diagnosis.
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