Multiple Sclerosis in a Nigerian Alcoholic Male: A Case Report from Enugu, South East Nigeria

BACKGROUND Multiple sclerosis is a rare neurological disorder in black Africans. In Nigeria it had been difficult to confirm suspected cases due to the paucity of diagnostic facilities. The availability of magnetic resonance imaging has enabled an increased confidence in making the diagnosis. METHOD This is a case report of a 40- year old Nigerian farmer of the Igbo ethnic group living in a rural community in Enugu who presented with clinical features suggestive of multiple sclerosis. Though the patient had a significant history of alcohol consumption, he had clinical and magnetic resonance imaging features diagnostic of multiple sclerosis. RESULTS A 40-year old male farmer presented to the Neurology Clinic of the University of Nigeria Teaching Hospital Enugu in January 2010 with a 10-year history of recurrent episodes of weakness of the legs. Each episode was sudden, affected either limb alternately, was associated with paraesthesiae and would resolve spontaneously after a few days or weeks without any intervention. Over the years he became unable to walk. The sphincters and vision were unaffected. A week prior to presentation he developed tremors of the hands with disorientation. The patient exhibited confabulation and had flaccid quadriparesis with glove and stocking sensory loss. Spinal fluid protein was raised and there were classic periventricular and intracerebral white matter hyper-intensities on magnetic resonance imaging. CONCLUSION This report of a case of multiple sclerosis suggests a need for clinicians in Africa to increase their index of suspicion in probable clinical scenario especially where magnetic resonance imaging exists.