Paroxysmal dystonia as an initial presentation of multiple sclerosis posing a diagnostic challenge

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Figure 1
Axial FLAIR shows A) hyperintense subcortical lesions, some of them are perpendicular and periventricular. B) Sagittal FLAIR image shows hyperintense subcortical lesions. C & D) T1 weighted images axial and sagittal showing post gadolinium enhancement of right subcortical lesion at corona radiata.

Table 1

Timeline of relevant past medical history and interventions.

Date	Relevant past medical history and interventions
27-02-2019	None
Date	Summarize form initial and Follow-up Visits	Diagnostic Testing (Including dates)	Interventions
28-02-2019	Recurrent, sudden painful, stereotyped episodes of movements affecting left upper and lower extremities leading to tonic posturing lasting between 15-30 seconds	MRI brain (3-3-2019) showed multiple foci of high signal intensity in T2/FLAIR weighted image along periventricular and juxta cortical region of both cerebral hemispheres, with pathological enhancement in one lesion representing interval disease activity	Carbamazepine 200 mg twice daily
28-02-2019	Frequency was 15-20 times a day	28-02-2019 Oligo clonal bands were not detected. Paraneoplastic panel and anti-aquaporin 4 antibodies were also negative	5 days course of Methylprednisolone
15-12-2018	Left eye blurring of vision	28-02-2019 No electrographic abnormalities were found in Electroencephalogram (EEG)
01-02-2018	Left sided weakness and numbness