Manifestation inaugurale atypique dans la sclérose en plaques : des nerfs hors pair

While multiple sclerosis (MS) is frequently revealed by optic neuritis, isolated implication of another cranial nerve is rare and multiple palsies are exceptional. A 35-year-old patient was admitted for right central facial palsy, left ptosis, dysgeusia, right deviation of the uvula, a vestibular syndrome (implication of nerves III, VII, VIII, IX, X) and a cerebellar syndrome. Many diagnosis were discussed: cerebral infarct, infectious meningitis, systemic inflammation, carcinomatous meningitis, diabetes. Complementary explorations were suggestive of central nervous system inflammation. The diagnosis of MS was confirmed when a second clinical event occurred. This is an exceptional etiology of multiple cranial nerve palsies but it should be explored when the first-line search is normal.