San Juan MS Center

Author Of 1 Presentation

Observational Studies Poster Presentation

P0886 - Multiple Sclerosis diagnosis at USNS Comfort during the aftermath of Hurricane Maria: A Case Report (ID 1870)

Speakers
Presentation Number
P0886
Presentation Topic
Observational Studies

Abstract

Background

The early diagnosis of Multiple Sclerosis (MS) is important for prognosis. On September 20, 2017 Hurricane Maria (HM) passed through Puerto Rico (PR) leaving severe devastation on its path. The electric infrastructure on the island collapsed, gasoline was rationed, medications were scarce and daily living was a challenge for patients with chronic conditions. The island has a high prevalence of MS (70.6/100,000), approximately 156 neurologists and 69 hospitals, most of which were not connected to the electric grid or habitable after the hurricane. Due to the lack of fully operational hospitals and medical offices, patients in need of medical attention did not have many options.

Objectives

We aim to highlight the effects of Hurricane Maria natural disaster in the diagnosis and treatment of an MS patient in Puerto Rico.

Methods

A case review was performed to describe the diagnosis process of a patient during the aftermath of Hurricane Maria on the island.

Results

A 41 y/o Puerto Rican woman had an episode of hemi paresthesia when she was 20y/o it was associated with stress and disregarded. Two weeks prior to HM she was presenting diplopia, internuclear ophthalmoplegia, ataxia and fatigue which worsened immediately after the event. Patient went to a local hospital but she was only referred to a neurologist and discharged. She decided to go on board the USNS Comfort (USNSC) due to the unavailability of medical appointment with neurologists on the island. Due to clinical signs presented and history of symptoms, MS was suspected, but no functional MRI facilities were available to confirm diagnosis. Methylprednisolone was administered and improvement of symptoms was observed. Diagnosis was made without MRI to confirm lesions. Fingolimod was recommended as treatment, but it was not available due to the scarcity of resources and MS treatments. Eventually, fingolimod was provided to the patient. Follow-up with a neurologist for evaluation and MRI of brain performance were advised. Five months after the hurricane, the MRI showed periventricular white matter lesions, some juxtacortical lesions and a single callosal lesion that were not active. Also, black hole was present in the right peri-atrial white matter supporting diagnosis.

Conclusions

This case demonstrates the importance of disaster guidelines for the management of possible diagnosis of MS, availability of functioning MRI facilities and consequent availability of treatment in the hope of preventing progression on these patients. Future work could include creation of collaborations between pharmaceutical companies and MS foundations to receive and distribute DMT samples in case of natural disasters.

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