Atypical Onset of Primary Progressive Multiple Sclerosis
Saima Nasreen, Sara Babar
Keywords: Multiple sclerosis, autoimmune disease, psychiatric symptoms, emotional lability, primary progressive MS
ABSTRACT
Multiple Sclerosis (MS) is a chronic autoimmune disorder characterized by demyelination of axons in the central nervous system. While it commonly presents with physical symptoms, psychiatric manifestations such as emotional lability or delirium can be the first indicators in rare cases. These early symptoms are often overlooked until significant physical disability develops. We report a case of a young woman who initially experienced unexplained bouts of crying, laughing, and emotional instability, which were misdiagnosed as psychiatric illness. Her condition remained undiagnosed until she developed spastic paraplegia, leading to an extensive workup that confirmed primary progressive multiple sclerosis (PPMS). This case highlights the importance of considering organic causes when evaluating psychiatric symptoms, ensuring timely diagnosis and appropriate management.
INTRODUCTION
Multiple sclerosis (MS) is an inflammatory, demyelinating, and neurodegenerative disease with a diverse clinical presentation. Traditionally, MS has been diagnosed based on its classical neurological symptoms and disease course, typically relapsing- remitting or progressive disability patterns1. However, in rare instances, MS can manifest initially with psychiatric symptoms such as emotional lability or delirium, which can delay diagnosis2. Mahboobi et al. were among the first to report MS presenting as delirium rather than with neurological deficits3.This case report describes a young woman whose initial symptoms of emotional instability were dismissed as a psychiatric disorder until she developed profound neurological deficits, ultimately leading to a diagnosis of primary progressive multiple sclerosis (PPMS).
CASE REPORT
A 26-year-old woman presented with a two-year history of unexplained emotional outbursts, including frequent bouts of crying, weeping, and laughing without an identifiable trigger. She consulted multiple physicians, who attributed her symptoms to a psychiatric disorder, leading to her referral to a psychiatrist. Despite receiving psychiatric treatment, for which no medical records were available, her condition did not improve. Due to the social stigma surrounding mental illness, her family discontinued psychiatric consultations and sought alternative treatment from faith healers.
DISCUSSION
A 26-year-old woman presented with a two-year history of unexplained emotional outbursts, including frequent bouts of crying, weeping, and laughing without an identifiable trigger. She consulted multiple physicians, who attributed her symptoms to a psychiatric disorder, leading to her referral to a psychiatrist. Despite receiving psychiatric treatment, for which no medical records were available, her condition did not improve. Due to the social stigma surrounding mental illness, her family discontinued psychiatric consultations and sought alternative treatment from faith healers.
CONCLUSION
This case highlights the need for increased awareness of atypical MS presentations, particularly psychiatric symptoms. Physicians should remain vigilant in evaluating patients with unexplained emotional instability, ensuring that MS and other neurological conditions are considered before attributing symptoms solely to psychiatric disorders. Early recognition and diagnosis can lead to timely intervention, potentially improving patient outcomes.