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A 60-year-old man presented in 2007 with slowly progressive dysarthria, weakness of the facial muscles and difficulty swallowing, which started 1 year before he was referred to our hospital with a diagnosis of multiple sclerosis. The medical history revealed decreased vision caused by a severe occlusive retinopathy (figure 1), hypertension, mild renal failure and Raynaud phenomenon. At neurological examination, we noticed a pseudobulbar dysarthria, and weakness of the facial muscles and tongue. Pseudobulbar reflexes could be elicited. Arms and legs were unaffected. Gait was a little slow but otherwise undisturbed.
Cerebral MRI showed bilateral subcortical white-matter lesions underlying …
Competing interests None.
Patient consent Obtained.
Provenance and peer review Not commissioned; externally peer reviewed.