Hoarseness, a major presenting symptom in a patient with multiple sclerosis

Multiple sclerosis (MS) is a chronic neurological disease with different presenting symptoms. We introduce a case of MS presented with hoarseness. A 38-year-old man complaining of hoarseness was referred to our clinic for a sudden palsy of right IX and X cranial nerves. Neurological examination showed signs of right IX and X cranial nerves paralyses, hoarseness, fine unidirectional horizontal nystagmus to the left and bilateral loss of cutaneous abdominal reflexes. Brain MRI revealed McDonald criteria for diagnosing MS. Pulse therapy was started and he recovered in 2 months. Beta interferon 1a began for him and in 9 months follow up, no relapse occurred.