Multiple Sclerosis During Pregnancy and the Postpartum Period: Diagnostic and Multidisciplinary Challenges in Two Cases.
Putri Nadya Syahidah, Setyorini Irianti, Johanes Cornelius Mose et al.
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Case in brief
The report describes two pregnant women with progressive focal neurological symptoms and brain MRI abnormalities concerning for central nervous system demyelination. A 27-year-old woman with autoimmune spondyloarthritis developed dizziness, gait instability, asymmetric weakness, paraesthesia, and neuropathic pain; postpartum MRI showed juxtacortical hyperintense lesions. A 24-year-old woman developed right-sided weakness, visual disturbance, and headache, with periventricular and subcortical hyperintense lesions on MRI; her neurological symptoms worsened in the early postpartum period. Both had preterm delivery, but incomplete investigations meant a definitive multiple sclerosis phenotype could not be confirmed retrospectively.
What made this case unusual
Neurological symptoms and MRI lesions raised concern for demyelinating disease in both pregnancies, yet the diagnostic work-up was insufficient to establish a definitive multiple sclerosis phenotype.
Diagnostic / clinical pearl
In pregnancy and postpartum, interpret neurological symptoms and MRI abnormalities cautiously; when investigations are incomplete, avoid assigning a definitive multiple sclerosis phenotype and ensure continued postpartum assessment.
Why it matters
The report underscores the value of multidisciplinary neurological, radiological, and obstetric assessment, while cautioning that these cases do not establish a causal link between suspected demyelinating disease and adverse obstetric outcomes.