People who have had traumatic brain injuries (TBIs) are at an increased risk of developing multiple sclerosis (MS). At the Consortium of Multiple Sclerosis Centers (CMSC) 38th Annual Meeting, researchers presented a case study of a 71-year-old White man who was diagnosed with clinically isolated syndrome (CIS) after experiencing a traumatic brain injury.

The patient had been hit in the left temple and then fell, hit the right side of his occiput on the ground, and fainted. His initial CT scan results that were taken immediately after the trauma were negative for acute changes. However, he developed a daily throbbing headache associated with nausea, blurrier vision in both eyes, increased tinnitus, and episodes of vertigo. He also experienced symptoms of increased drowsiness, abnormal gait, generalized weakness, and slowing of speech. Additional exams founds that the patient had a constricted visual field in his entire left eye and truncal ataxia.

These results prompted the researchers to complete further tests, including a fluid-attenuated inversion recovery MRI brain and spine exam, which showed multiple hyperintense lesions in the periventricular and cortical regions with no enhancing, brainstem, or spinal lesions. Other exams performed included a fundoscopic exam, which showed an optic nerve pallor in the patient’s left eye, and a lumbar puncture, which was negative for oligoclonal bands. Following these results, the patient was treated with corticosteroids for possible MS. The treatment led to improvement with his speech difficulty, dizziness, vision, and headache.

Neurologic symptoms such as headaches and vertigo can typically develop after a person has a TBI. However, the researchers suggest that when a patient is experiencing ataxia, they should undergo further examinations, including fundoscopic examination MRI, and/or ophthalmology consultation as these symptoms can develop into a demyelinating disease such as MS.

Reference

Srifuengfung G, Suppakitjanusant P. Clinically isolated syndrome presenting with visual loss, headache, unsteadiness after a traumatic brain Injury: a case report. Presented at: CMSC 2024; May 29-June 1, 2024; Nashville, TN; Abstract CS09.