DYSTONIA DUE TO CERVICAL MYELITIS AS PRESENTING SYMPTOM OF MULTIPLE SCLEROSIS – REPORT OF TWO CASES AND REVIEW OF LITERATURE

Abstract

Dystonia is usually associated with lesions in the basal ganglia, thalamus, cerebral peduncle or internal capsule. We report two patients who presented with dystonia as first symptom and were diagnosed with MS afterwards. Brain MRI showed demyelinating lesions in the periventricular or subcortical white matter, the corpus callosum and the cerebellum without any involvement of the usual sites responsible for dystonia mentioned above. MRI of the cervical spine showed in both patients more than one lesions mostly at the upper level of the cervical spinal cord. Dystonia improved after administration of methylprednisolone in both patients. We consider that dystonia may be the presenting symptom of multiple sclerosis caused by cervical spinal cord lesions.