Acute, multifocal neurological symptoms
Kitley J., Palace JA., Rocca MA., Filippi M.
© Cambridge University Press 2014. When a patient presents with multiple neurological symptoms not referable to a single anatomical location, they are said to have multifocal neurological symptoms. Although common in chronic disorders, where disease burden increases and spreads over time leading to progressive accumulation of symptoms and signs, multifocal neurological symptoms occurring acutely are relatively rare. When they do occur, they are usually caused by disorders of the central nervous system (CNS). Occasionally, peripheral nervous system disorders can also give rise to acute multifocal symptoms, for example in the context of mononeuritis multiplex. However, imaging plays little role in the evaluation of such patients and thus this chapter will focus primarily on acute CNS disorders. CNS disorders causing multifocal neurological symptoms are usually inflammatory in nature. Although “dissemination in space,” a term synonymous with multifocal CNS involvement, is usually reserved for multiple sclerosis (MS), many other inflammatory disorders can cause dissemination in space. The most frequent of these are acute disseminated encephalomyelitis (ADEM) and neuromyelitis optica (NMO), and these three disorders will form the bulk of this chapter. However, we will also briefly touch upon other inflammatory and non-inflammatory disorders that may also present with multifocal neurological symptoms.