Multiple Sclerosis and Intracranial Hypertension Presenting as Paroxysmal Kinesigenic Dyskinesia

Background: Paroxysmal movements in the form of tonic spasms, dystonia, choreoathetosis and hemidyskinesia have been reported in patient with multiple sclerosis (MS). Intracranial hypertension with headache and papilledema resembling idiopathic intracranial hypertension (IIH) exceptionally occurs in patient with MS. Conversely, IIH may rarely present as movement disorder in children. Aims of the study: Report an unusual patient with MS and intracranial hypertension anteceded by movement disorder. Methods: Clinical examinations and ancillary diagnostic testing. Results: A 54 year old patient presented one year earlier to her diagnosis of MS with symptoms of paroxysmal kinesigenic diskinesia (PKD). Her initial neurologic examination and brain MRI were normal. A year later her examination became abnormal and her MRI showed demyelination. Her cerebrospinal fluid contained oligoclonal bands and the opening pressure was markedly elevated, in the absence of headache and papilledema. Conclusion: PKD may antecede MS and acephalgic intracranial hypertension without papilledema in exceptional patients.