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What is the typical age range for the onset of multiple sclerosis?
What is the typical age range for the onset of multiple sclerosis?
What is the percentage of MS patients who demonstrate an initial onset characterized by a relapsing-remitting course?
What is the percentage of MS patients who demonstrate an initial onset characterized by a relapsing-remitting course?
What is the term used to describe a single episode of inflammatory CNS demyelination?
What is the term used to describe a single episode of inflammatory CNS demyelination?
What is the ratio of multiple sclerosis prevalence in females compared to males?
What is the ratio of multiple sclerosis prevalence in females compared to males?
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What is the approximate number of individuals with multiple sclerosis in the United States?
What is the approximate number of individuals with multiple sclerosis in the United States?
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What is the characteristic of the primary progressive (PP) course of multiple sclerosis?
What is the characteristic of the primary progressive (PP) course of multiple sclerosis?
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What is the term used to describe the characteristic of multiple sclerosis lesions?
What is the term used to describe the characteristic of multiple sclerosis lesions?
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What is the percentage of MS patients who present with a gradual deterioration from the onset?
What is the percentage of MS patients who present with a gradual deterioration from the onset?
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What is the characteristic of the relapsing-remitting (RR) course of multiple sclerosis?
What is the characteristic of the relapsing-remitting (RR) course of multiple sclerosis?
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What is the term used to describe the phenomenon where multiple sclerosis lesions occur at different times and in different CNS locations?
What is the term used to describe the phenomenon where multiple sclerosis lesions occur at different times and in different CNS locations?
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Study Notes
Multiple Sclerosis (MS)
- MS is an autoimmune disease of the central nervous system (CNS) characterized by chronic inflammation, demyelination, gliosis, and neuronal loss.
Clinical Features
- Vision symptoms: vision loss, double vision, optic neuritis
- Vestibular symptoms: vertigo, gait imbalance
- Bulbar dysfunction: dysarthria, dysphagia
- Motor: weakness, tremor, spasticity, fatigue
- Sensory: loss of sensation, paresthesia, dysesthesias
- Urinary and bowel symptoms: incontinence, retention, urgency, constipation, diarrhea, reflux
- Cognitive symptoms: memory impairment, impairment of executive functions, trouble concentrating
- Psychiatric symptoms: depression, anxiety
Investigations
- MRI brain and spinal cord with contrast
- CSF analysis
- Evoked potentials (optional)
- Blood studies: CBC, TSH, vitamin B12, sedimentation rate, and ANA
MRI Findings
- Lesions are T2 hyperintense (white), T1 isointense/hypointense
- Lesions are classically oval
- High predilection for periventricular white matter
- Lesions are perpendicular to the ependymal surface (Dawson's fingers)
- Contrast enhancement with active lesions: diffuse or rim enhancement
- Cord lesions typically involve the cervical or thoracic cord
CSF Findings
- Elevated protein
- Leukocytes less than 50 (occasionally seen, typically mononuclear cells)
- Increased total IgG index, oligoclonal bands
Differential Diagnosis
- Other demyelinating or inflammatory CNS syndromes: optic neuritis, acute disseminated encephalomyelitis, neuromyelitis optica, partial transverse myelitis
- General inflammatory and autoimmune syndromes: systemic lupus erythematosus
- Infectious etiologies: Lyme disease, HIV, herpes viruses
- Vascular etiologies: migraine headaches, vascular malformations, emboli
- Metabolic causes: vitamin deficiencies, thyroid disease
- Neoplastic causes: primary CNS malignancies, metastasis
Prognosis
- Varies between patients
- Almost 10% of cases present before the age of 18
Pathogenesis
- Focal inflammation resulting in plaques and injury to the blood-brain barrier (BBB)
- Neurodegeneration with microscopic injury involving different components of the CNS: axons, neurons, synapses
Disease Course
- Relapsing-remitting (RR): 70-80% of MS patients, characterized by exacerbations and relapses
- Primary progressive (PP): 15-20% of patients, gradual deterioration from the onset
- Secondary progressive (SP): gradual neurologic deterioration after an initial RR course
- Clinically isolated syndrome (CIS): a single episode of inflammatory CNS demyelination
Etiology
- Unknown, but factors involved in pathogenesis include:
- Immune factors: autoimmune attack on the CNS
- Environmental factors: latitudinal gradients, vitamin D deficiency, infections (e.g. Epstein Barr virus)
- Genetic associations
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Description
This quiz covers the diagnosis of multiple sclerosis, including the clinical evidence, investigations, and MRI features of the disease. It also discusses the typical appearance of lesions on MRI scans.
