Multiple Sclerosis on Steroids

A 57-year-old man developed acute bilateral vision loss clinically consistent with bilateral optic neuritis. Within 1 month of diagnosis, he developed progressive and severe neurologic dysfunction, and repeat MRI demonstrated enhancement of the optic chiasm and optic tracts, as well as a large enhancing lesion within the right parieto-occipital lobe. Stereotactic-guided brain biopsy demonstrated demyelination consistent with multiple sclerosis. A diagnosis of fulminant multiple sclerosis was made. The patient died within 2 months of diagnosis. Multiple sclerosis and a fulminant subtype known as Marburg disease are discussed.