A woman in her 50s with genetically confirmed Huntington’s disease presented with right-sided arm sensory symptoms that evolved over days and persisted for at least 1 month. Neurological examination revealed mild right arm hypoesthesia and mild generalised choreiform movements. Brain MRI demonstrated multiple supratentorial and infratentorial lesions suggestive of demyelination, along with a short-segment, contrast-enhancing cervical spinal cord lesion. Cerebrospinal fluid analysis revealed type 2 IgG-restricted and type 4 IgM-restricted oligoclonal bands. Comprehensive testing for infectious, paraneoplastic, metabolic and other autoimmune aetiologies yielded negative results. A diagnosis of relapsing-remitting multiple sclerosis was established, based on the 2024 McDonald criteria and after exclusion of alternative diagnoses. Dimethyl fumarate was initiated, with neither adverse effects nor new clinical relapses or MRI lesions. This case highlights the need to remain alert to subjective neurological symptoms in patients with Huntington’s disease, ensuring that new manifestations are not automatically attributed to a single disease process.
Appiani et al. (Wed,) studied this question.