Rasoul-e-Akram Hospital, Tehran University of Medical Sciences, Tehran, Iran.
Neurol Sci. 2011 Oct;32(5):953-7. doi: 10.1007/s10072-011-0723-0. Epub 2011 Aug 24.
Fulminant multiple sclerosis (MS) is the most malignant form of MS which usually leads to death in few weeks. Although it can be accompanied by optic neuritis (ON), but long interval between ON and the grave onset has not been reported. Fulminant MS usually occurs as the first onset and previous ON is not common. We report a rare case of 30-year-old woman with a history of ON 1 year ago. The rapid deterioration to vegetative state followed by a seizure and previous ON differentiated this case from previous reported cases. The differential diagnosis of a rapidly progressive leucoencephalopathy in this patient includes inflammatory, vascular, infectious and toxic disorders. Regarding the previous history of optic neuritis with positive brain MRI (multiple T2 hyperintense lesions in white matter) in our patient, multiple sclerosis is the most probable diagnosis. More effective treatments, such as plasmapheresis and cyclophosphamide, that influenced on the prognosis of some previous patients could be useful, but should be performed before progressive brain atrophy emerges.
暴发性多发性硬化症（MS）是 MS 最恶性的形式，通常在数周内导致死亡。尽管它可能伴有视神经炎（ON），但 ON 和严重发作之间的长间隔时间尚未报道。暴发性 MS 通常作为首发，以前的 ON 并不常见。我们报告了一例罕见的 30 岁女性病例，该患者 1 年前有 ON 病史。从意识清醒状态迅速恶化到植物人状态，随后出现癫痫发作和以前的 ON，这与以前报道的病例不同。该患者迅速进展性脑白质病的鉴别诊断包括炎症、血管、感染和中毒性疾病。关于我们患者以前的视神经炎病史和阳性脑 MRI（脑白质内多个 T2 高信号病变），多发性硬化症是最可能的诊断。一些以前的患者有效的治疗方法，如血浆置换和环磷酰胺，可能会影响预后，但应在进行性脑萎缩出现之前进行。
