# A Case Report on Multiple Sclerosis Associated With Atrial Fibrillation and Neurogenic Hypertension: Area Postrema Syndrome?

## TL;DR

A rare case of multiple sclerosis is reported where the patient developed heart rhythm issues and high blood pressure due to brainstem damage.

## Contribution

This case highlights the rare link between area postrema demyelination and neurogenic hypertension in multiple sclerosis.

## Key findings

- Demyelination in the area postrema was associated with atrial fibrillation and acute hypertension.
- Bell's palsy can be an early sign of MS relapse.
- MRI showed extensive demyelination in the brainstem and cerebral hemispheres.

## Abstract

Multiple sclerosis (MS) is an autoimmune demyelinating neurological disorder primarily manifesting with a range of neurological symptoms, with cardiovascular autonomic involvement being a rare occurrence. We report a case where a patient initially presented with Bell's palsy, without other notable symptoms or signs, and subsequently developed atrial fibrillation, hypertension, and hemiparesis. Magnetic resonance imaging (MRI) revealed extensive demyelination in the cerebral hemispheres, brainstem, and notably, the area postrema. The anatomy of the area postrema and its connections, in relation to neurogenic hypertension, are discussed. The demyelination in the area postrema was thought to be the cause of our patient’s arrhythmias and acute hypertension. Furthermore, we discuss the cerebral origins of cardiac arrhythmias, with a focus on MS and other neurological conditions. This case underscores the rarity of isolated cranial neuropathies, such as Bell's palsy, as an initial sign of MS, marking the onset of a relapse.