Neurological worsening due to infection from renal stones in a multiple sclerosis patient

Symptomatic bladder dysfunction occurs in the majority of patients with mul tiple sclerosis (MS). Although guidelines have been established for diagnos is and management of bladder dysfunction in these patients, they are someti mes overlooked in the primary core setting, leading to severe, life threate ning complications. A 64-year-old mole with a 31-year history of spastic qu adriparetic MS and neurogenic bladder dysfunction managed with on indwellin g catheter, presented to the hospital with worsening neurological function. He had developed increased weakness and cognitive impairment several weeks after being treated for a urinary trace infection (UTI). He hod become una ble to perform any activities of daily living or drive his power wheelchair . After on extensive work-up, he was found to have a large (14 x 18 x 30 cm ) retroperitoneal abscess and multiple renal stones, including a large obst ructing calculus in the collecting system near the ureteropelvic junction, end he underwent nephrectomy end abscess drainage. Of note, he had been fou nd to have multiple renal stones end hydronephrosis on renal ultrasound 3 y ears earlier, but he had received no treatment Following drainage of the ab scess, his upper extremity neurological function returned to baseline, his cognitive status improved and he regained the ability to perform activities of daily living. Patients with paralysis from MS, much like those with tra umatic spinel cord injuries, are at grave risk of mortality and morbidity f rom undiagnosed and under-treated urinary complications. This case demonstr ates that evaluation end appropriate treatment for complications of neuroge nic bladder should be part of routine care for patients with MS. Current re commendations for evaluation and management of bladder dysfunction in patie nts with MS will be reviewed.