European Journal of Neurology 2007, 14: e34–e35

doi:10.1111/j.1468-1331.2006.01497.x

LETTER TO THE EDITOR
Unilateral progressive brain lesions
confirmed as multiple sclerosis
K. Mitosek-Szewczyka, P. Luchowskia,
B. Jaroszb and Z. Stelmasiaka
a

Department of Neurology, Medical University of Lublin; and bNeuropathological
Laboratory, Department of Neurosurgery,
Medical University of Lublin, Lublin,
Poland

Correspondence: Krystyna MitosekSzewczyk, Department of Neurology,
Medical University of Lublin, Jaczewskiego 8, 20–090 Lublin, Poland (tel.: +48 81
7244720; fax: +48 81 7425534; e-mail:
krystyna.mitosek@am.lublin.pl).
Keywords: brain biopsy, multiple
sclerosis, symptomatic epilepsy

hyperreflexia, bilaterally presented Babinski’s sign and clonus. MRI revealed the
presence of few T2 hyperintensities in the
periventricular region, two lesions within
the corpus callosum, as well as few cortical–subcortical lesions limited to the right
hemisphere (Fig. 1a). Vasogenic brain
lesion and symptomatic epilepsy was
diagnosed. MRI scans, performed
6 months and 3 years later, revealed minimal or even no changes when compared
with the previous one. At the age of 24,
emotional disturbances were present
(panic disorder, generalized anxiety disorder) and the patient was hospitalized in
Psychiatric Department. One year later,
the occurrence of seizures had increased
and she started complaining of left limb
weakness. At this time she was admitted
to our Department. Neurologically, a
slight upper left limb paresis with pyram-

Received 26 September 2005
Accepted 12 December 2005
Multiple sclerosis (MS) often demonstrates highly variable clinical course and
some heterogeneity in histopathology [1].
The diagnosis of MS is based on a classic
history and symptoms and/or typical
findings on magnetic resonance imaging
(MRI). Newer MRI techniques, such as
MR spectroscopy (MRS) promise to yield
important information regarding MS
recognition, prognosis, and treatment
effects [2]. We report a case of MS confirmed by brain biopsy, that did not fulfill
McDonald’s criteria [3].
Our patient at the age of 19 had her
first episode of seizures (initially adverse,
later on grand-mal epilepsy). Physical
examination was normal, whilst neurologic examination demonstrated four-limb

a

b

c

d

e

f

g

h

Figure 1 Magnetic resonance imaging (a–c). Hyperintensities on axial brain images in 1996 (a) and sagittal (b) and axial (c) images 6 years
later. Histopathological examination (d–h). Perivascular infiltration of lymphocytes (d) and macrophages (e) within white and gray matter,
with reactive gliosis (f). Kluver–Barrera staining showed demyelinated areas (g) with axon preservation (h) (For details see text).

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Ó 2007 EFNS

Letter to the Editor
idal signs and four-limb hyperreflexia was
present. Standard laboratory workup revealed no abnormalities. Brain imaging
study showed huge progress of the process, still limited to the right hemisphere
(Fig. 1 b and c). Cerebrospinal fluid
examination detected no atypical cells and
the glucose level was normal. Meanwhile,
the presence of oligoclonal bands was
demonstrated. Further, we excluded
leucodystrophies, neuroborreliosis,
mitochondrial cytopathy and vasculitides.
As the diagnosis was uncertain, the patient
underwent MRS which suggested active
parasitic process rather than myelin
breakdown or neoplasm. The absence of
antibodies against toxoplasmosis, toxocariasis and cysticercosis rules out the presence of these pathologies. Finally, the
patient underwent biopsy and brain
pathologic tissue was taken for histopathologic examination. The biopsy
material was routinely formalin-fixed,
paraffin-embedded and stained with
hematoxylin and eosin. Immunohistochemical reactions were performed in the

Department of Clinical Pathology of the
Medical University of Lublin using the
following antibodies: Glial fibrillary acidic
protein (GFAP), Neurofilament protein
(NFP) and CD68 (all 1:50). The histopathologic examination revealed perivascular infiltration of lymphocytes (Fig. 1d)
and macrophages (CD68+) (Fig. 1e)
within white and gray matter with reactive
gliosis (GFAP+) (Fig. 1f). Luxol fast
blue-cresyl fast violet stain showed demyelinated areas (Fig. 1g) with axon preservation (NFP+) (Fig. 1h), typical findings
characteristic of MS disease [4].
In conclusion, we report on a patient
with progressive one-side brain abnormalities, diagnosed as MS. Epileptic seizures were one of the first symptoms to be
observed and they were in agreement with
data demonstrating three to six times
higher prevalence of epilepsy in MS
patients [5]. To our knowledge, there have
been no reports of such long-term disproportion of pathology between hemispheres in the course of MS.

Ó 2007 EFNS European Journal of Neurology 14, e34–e35

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