Remitting long-standing major depression in a multiple sclerosis patient with several concurrent conditions

Figures & data

Figure 1 Signs observed in the current case.

Notes: (A1, A2) Congenital hyper-flexibility type EDS (red arrows, elbows);^4,5 (B1, B2) recurrent urticaria and eczema on torso (B1) and hands (B2);^4,5 (C) MS and MDD-related ventricular enlargement and occipital lobe bending (OLB, blue and white arrows, respectively);^1,2,6 OLB is also shown in (G). (D) EDS-related unilateral periventricular heterotopia (PH, red arrow), which supports the patient’s dyslexia diagnosis.⁷ (E) Red arrow, MS lesions along body and splenum of corpus callosum. They indicate difficulties in coordinating R/L hands and may portend cognitive decline.^8,9 Yellow arrow – craniopharyngioma (0.9 cm³) comprising papillary (soft, anterior), and adamantinous (hard, posterior) cysts bound by a single epithelium.^10–12 (F) Yellow arrow, conjoined craniopharyngioma cysts (soft ~2.3 cm³ and hard ~0.5 cm³). At this stage, the tumor pressed against his optic chiasm (thin gray arch above the cyst, blue arrow) and caused bitemporal hemianopsia (bilateral peripheral vision losses).^10–12 (G) Red arrow, EDS-related nasal cartilage defect.^4,5 White arrow, OLB.⁶ Yellow arrows, single voxel (box) MRS of papillary cyst showing characteristic alkyl fats and hydroxyl resonances at δ ≅1–2 and 3.5–4.2 ppm, respectively. Other CNS metabolites are not seen in papillary craniopharyngioma tumors. These MR-spectral characteristics are only seen in papillary craniopharyngiomas.^11,12 Adamantinous cysts do not display MR-spectral resonances. Note, in this case report the corresponding author (NDS) is the patient.
Abbreviations: EDS, Ehlers Danlos Syndrome; MS, multiple sclerosis; MDD, major depressive disorder; OLB, occipital lobe bending; R, right; L, left.

Table

0–15 = Euthymia to mild mood disturbances with life’s ups and downs; 16–20 = Mild to intermediate clinical depression; 21–30 = Moderate depression; 31–40 = Severe depression; > 40 = Extreme depression.

Note: Data from Veauthier et al¹⁹ and Benedict et al.²⁰

Table

Asthma and Allergies: Allegra^® (180 mg), Fluticasone propionate (50 micro-g, 2 puffs, PM), Singulair^® (10 mg), Albuterol sulfate (as needed), Pulmicort (2 puffs), Epi-pen (when needed). Benign prostate enlargement: Tamsulosin^® (20 mg). GERD: Nexium(20 mg). High BP: Losartan/HCTZ (100/25 mg), Amlodipine Besylate (25 mg), Aspirin(80 mg). Hypothyroidism: levothyroxine (200 micro-g). Hyperlipidemia: Lipitor (20 mg). Intension tremors: propranolol (20 mg). Major Depression: Bupropion^® (150 mg ×2) and S-adenosylmethionine (400 mg). Multiple sclerosis: Vitamin-D3 (5000IU) and Vitamin-E (500 mg). Anemia: Vitamin-B12 (1000 mcg). Type 2 diabetes mellitus: metformin^® (1g, 2x), Nateglinide^® (250 mg, 2x), Januvia^® (100 mg), Levemir^® (65IU). Urticaria: Cloebetasol Propionate USP (0.05%) and Clotrimazole and Betamethasone Dipropionate (1% and 0.50% base) creams, as needed; and Cetirizine (10 mg at bedtime during itchy flare-ups).

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