Abstract

Multiple sclerosis is a chronic demyelinating disease of the central nervous system with neurologic manifestations presenting temporally and spatially during the life of the patient. Multiple sclerosis confers a known risk of concomitant psychiatric disorders in adults and this association likewise extends to the pediatric multiple sclerosis population, despite the relative rarity of multiple sclerosis in children. This report centers on the case of a 14-year-old female with a two-year-history of suicide attempts, suicidal ideation, and suicidal behavior with concurrent psychiatric and neurological symptomatology. The patient presented to a Level 1 Trauma Center with acute hypoxic respiratory failure status post successful resuscitation of cardiopulmonary arrest following a suicide attempt by asphyxiation. Cerebral imaging studies performed on arrival incidentally revealed evidence of actively demyelinating lesions concerning for multiple sclerosis. The diagnosis was confirmed with a cerebrospinal fluid (CSF) analysis significant for elevated oligoclonal bands and kappa light chains. The purpose of this report is to draw attention to suicidality as an unusual but potentially fatal presenting symptom of multiple sclerosis in adolescents and to encourage diagnosticians to consider underlying neurological disease as a cause of suicidal behavior in the pediatric population.