Sophia M Raefsky, Amit Chaudhari, Michael Y. Sy, Delayed-Onset multiphasic demyelinating lesions after high dose radiofrequency electromagnetic field exposure: A multiple sclerosis (MS) mimic, Multiple Sclerosis and Related Disorders, Volume 45, 2020, 102318, ISSN 2211-0348, https://doi.org/10.1016/j.msard.2020.102318.
Highlights
Our patient is a 46-year-old Caucasian engineer with no significant past medical history. In 2011, he was exposed to prolonged high levels of radiofrequency electromagnetic field (RF-EMF) radiation during a technical malfunction at a cell phone tower. Unfortunately, a radiation monitor was not worn during the incident but company guidelines suggested that only 6 min of exposure was safe. In contrast, the patient remained directly in front of 15 active transmitters for at least 2 h. Immediately post exposure, he suffered cutaneous burns to his face, neck, and back, and developed eye, joint, muscle and stomach pain. An MRI brain with and without contrast at the time was unremarkable and his symptoms resolved completely after a few days of supportive treatment. Unfortunately, in 2016, our patient started to have right hand weakness and numbness. Initial outpatient MRI of the cervical spine revealed mild-to-moderate spinal stenosis. He underwent an anterior cervical discectomy and fusion of C4-C7 the same year, though his symptoms only partially resolved. In 2017, he re-presented to the primary care clinic with new-onset left arm and hand weakness. Outpatient workup with an electromyogram revealed left ulnar neuropathy. He was then recommended to have an ulnar transposition, which he underwent successfully but with no symptomatic relief. Given the persistence of his symptoms, an MRI brain was ordered and he was referred to a Neurologist. Compared to the 2011 MRI brain which had been unremarkable, the T2 fluid attenuated inversion recovery sequence (T2 FLAIR) on this 2017 MRI brain showed multiple oval-shaped hyperintense lesions involving the juxtacortical, periventricular and deep white matter regions without restricted diffusion or enhancement (Fig. 1)….
In summary, this case illustrates that high levels RF-EMF exposure can either increase risk for the development of MS or induce a condition that mimics the presentation of multiple sclerosis both clinically and radiologically. Thus, extreme RF-EMF radiation should be kept in the differential diagnosis when taking a thorough neurological history. Despite case reports that corticosteroids may be effective in the prevention of sequential demyelination in oncological patients who received therapeutic whole brain radiation, our patient refused to try any therapies beyond pain control and we are unable to comment on their efficacy in this case. We encourage further investigations into the true incidence and mechanism of this disorder, with hopes that tailored therapies may soon become available for patients like ours.