Article Figures & Data
Figures
- Figure 1
Magnetic resonance imaging A&B) Cervical T2-weighted axial image from patient 1 showing hyperintense signals in the lateral cord. C) Sagittal fluid attenuation inversion recovery (FLAIR) image from patient 1 showing multiple hyperintense signals in supra-and infratentorial areas. D&E) Axial FLAIR image from patient 2 showing multiple hyperintense signals in supra- and infratentorial areas. F) Coronal contrast enhanced sequence from patient 2 showing a contrast-enhanced lesion. G&H) Axial FLAIR image from patient 3 showing multiple hyperintense signals in supra- and infratentorial areas. I) Axial sequence from patient 3 showing contrast-enhanced ring and open-ring lesions.
Tables
- Table 1
Timeline table shows demography, clinical features, investigations, therapeutic intervention and outcome in 3 patients with MS developed after weight loss.
Patient characteristics Patient 1 Patient 2 Patient 3 Gender Male Male Male Age at symptoms onset, at diagnosis (years) 18, 18 28, 28 21, 23 Modality of weight loss Diet Sleeve surgery Diet Weight lost (kg), time (months) 58, 3 87, 6 50, 6 Symptoms at presentation Bilateral lower limb numbness 5 months after weight loss Abnormal eye movement, paresthesia in upper and lower limbs, and imbalance 18 months after surgery Diplopia and right arm and leg paresthesia 2 years after weight loss Past history Fatigable ptosis, diplopia, dysarthria, and proximal limb weakness 2 months after weight loss Upper and lower limb paresthesia and sense of heaviness 10 months after surgery Bilateral lower limb paresthesia extending to the level of the umbilicus immediately after weight loss Clinical signs Normal Gaze-evoked nystagmus, appendicular ataxia, and impaired tandem gait Left abducens nerve palsy, right hemisensory loss of pain and temperature, right upper limb dysmetria, and impaired tandem gait MRI brain Multiple demyelinating lesions, a few of which were enhancing, located at subcortical and juxtacortical areas, corpus callosum, brainstem, and spinal cord Multiple supra- and infra-tentorial non-enhancing demyelinating lesions, and enhancing lesions in the brainstem Extensive white matter demyelinating lesions, a few of which were enhancing Laboratory workup ANA titre 1:1,280, low vitamin D level Low vitamin D elvel Normal Therapy for relapse Pulse methylprednisolone Pulse methylprednisolone Pulse methylprednisolone Disease modifying therapy Azathioprine and prednisone Natalizumab B1a interferon Follow-up at 1 year No clinical or radiological relapses No clinical or radiological relapses No clinical or radiological relapses MS - multiple sclerosis, kg - Kilogram, MRI - Magnetic resonance imaging
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