Neurorehatilitation and complex therapeutical approaches in a patient with spinal multiple sclerosis

The purely spinal form of multiple sclerosis, presenting as a progressive spastic paraparesis, hemiparesis, or, spastic monoparesis of a leg with varying degrees of posterior column involvement, is a special source of diagnostic difficulty. We present the case of a 47 years old patient, with no personal pathological antecedents, admitted in our department through the emergency ward for motor deficit of the lower limbs, sympthomatology that had an acute onset the day before admittance. The neurologic examination revealed: orthostatism and gait not possible, spastic paraparesis – 3/5 MRC (medical research council), deep tendon reflexes were found to be hyperactive on both lower extremities, bilateral plantar extension, a dermatomic level of sensory disturbance at T10 – T11 vertebral segment and urinary retention. The cerebral MRI revealed no pathological findings. The lumbar punction revealed oligoclonal bands and the spine MRI outlined multiple focal images with demyelination aspect reaching the cervical and dorsal level of the medullary cord. The patient had two more relapses each at approximately 6 months, and this allowed us to establish the final diagnostic: Pure spinal multiple sclerosis. Key words: spinal multiple sclerosis, paraparesis, neurorehabilitation