Ischemic Strokes in a Young Woman With Manifestations of Multiple Sclerosis

Background: The current case report aimed at describing the clinical, radiological, and immunological findings of a case of ischemic stroke due to acute thrombosis of the left internal carotid artery and multiple watershed infarctions mimicking Multiple Sclerosis (MS). Clinical Presentation and Intervention: A 24-year-old right-handed Iranian female was initially diagnosed with Multiple Sclerosis (MS). She presented with weakness in right lower limb. The cerebral Fluid Attenuation Inversion (FLAIR) Magnetic Resonance Imaging (MRI) showed few small and round lesions in deep white matter, semi-oval centrums, paraventricular region, and subcortical region on left hemisphere. MS was suspected. The patient’s neurological status worsened, after four days she presented hemi-paresis, dysarthria, and hemi-facial paresis. The cerebral Diffusion- Weighted (DW)-MRI, Apparent Diffusion Coefficient (ADC), Duplex Scan (DS), Complete Blood Count (CBC), coagulation, blood chemistry, blood lipids, and autoimmune and immunodiagnostic pathology were performed. Test for Anti-double stain DNA (dsDNA), IgG anti-cardiolipin antibodies, and lupus anticoagulant were positive. DNA bound lactoferrin, anti-Sm antibodies, Anti-Sjögren’s- Syndrome-related Antigen (Anti-SSA) autoantibodies, IgM anti-cardiolipin antibodies, and Antibeta- 2 glycoprotein-1 (IgMIgG) were negative. Ischemic stroke due to acute thrombosis of the left internal carotid artery and multiple watershed infarctions were confirmed in the patient. Heparin and then warfarin therapy was started. At that time she was treated with warfarin, hydroxychloroquine (200 mg/d) and atorvastatin (20 mg/d). The outcome was favorable. Conclusion: The current case presented with clinically susceptible symptoms of MS, but had a stroke. Therefore, stroke in young patients can mimic MS symptoms.