Pregnancy-Induced Atypic Demyelinating Inflammatory Disease

Abstract

We report a 34-year-old female patient with the sole medical history of thalassemia minor who presented with multiple sclerosis-like attacks, once after oral contraceptive (OC) use and three times following separate pregnancies. Her first episode began after I month use of OC at the age of 28, when she complained of bilateral blurred vision and confusion, which lasted a couple of days. She had 3 more episodes of dysarthria and right hemiparesis, behavioral change, and confusion, all of which occurred during the first trimester of 3 consecutive pregnancies and her last pregnancy was noticed during the last episode. Her attacks usually lasted a few weeks and resolved partially or completely following medical abortion. Her brain MRIs revealed a peculiar distribution of atypical multiple demyelinating lesions with contrast enhancement and her MRS was consistent with demyelination. Her routine hematological and biochemical laboratory tests were within normal limits other than mild microcytic anemia. A thorough investigation for vasculitis, rheumatologic disorders, infection, and thrombosis was also negative. Her CSF was normal, without oligoclonal bands. Although there is a known tendency to have remissions during pregnancy in demyelinating diseases, as seen in our case, demyelinating lesions may be triggered by hormonal and immunologic changes during pregnancy. (Archives of Neuropsychiatry 2009; 46: 80-3)