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Questions and Answers
Which of the following tests is NOT typically ordered to help diagnose multiple sclerosis (MS)?
What is the characteristic appearance of lesions in the brain of a patient with MS on MRI imaging?
What is the characteristic appearance of lesions in the spinal cord of a patient with MS on MRI imaging?
What is the typical appearance of lesions perpendicular to the ependymal surface in MS, also known as Dawson's fingers?
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Which of the following CSF findings is NOT typically seen in multiple sclerosis?
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Which of the following conditions is NOT included in the differential diagnosis for multiple sclerosis?
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Which of the following is NOT a common symptom associated with multiple sclerosis (MS)?
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What is the term used to describe the dissemination of lesions in different parts of the central nervous system (CNS) at different points in time, which is a key diagnostic criterion for MS?
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Which of the following investigations is typically NOT used in the diagnosis of MS?
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Which of the following is NOT a characteristic of the relapsing-remitting (RR) course of MS?
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Which of the following is NOT a typical finding on MRI in patients with MS?
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Which of the following is NOT a criterion for establishing dissemination in space (DIS) in the diagnosis of MS?
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Which of the following is the most common course of multiple sclerosis?
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Which of the following is required for the diagnosis of relapsing-remitting multiple sclerosis?
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What is the hallmark characteristic of lesions in multiple sclerosis?
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Which of the following is a key environmental factor involved in the pathogenesis of multiple sclerosis?
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What type of demyelination is characteristic of multiple sclerosis lesions?
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Which of the following MRI findings is most characteristic of multiple sclerosis lesions?
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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.
- The course of MS may be relapsing-remitting or progressive in nature.
Disease Course
- Relapsing-remitting (RR): 70-80% of MS patients demonstrate an initial onset characterized by a relapsing-remitting course.
- Primary progressive (PP): 15-20% of patients present with a gradual deterioration from the onset, with an absence of relapses.
- Secondary progressive (SP): characterized by a more gradual neurologic deterioration after an initial RR course.
- Clinically isolated syndrome (CIS): often classified as a single episode of inflammatory CNS demyelination.
Etiology
- The exact etiology of MS is unknown.
- Factors involved in pathogenesis broadly group into three categories:
- Immune factors
- Environmental factors
- Genetic associations
Symptoms
- 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
MS Relapse
- The RR course of MS is characterized by exacerbation and relapses of neurological symptoms, with stability between episodes.
- Features of RR course of MS:
- New or recurrent neurological symptoms
- Symptoms developing over days and weeks
- Symptoms lasting 24 to 48 hours
Diagnosis
- Dissemination in space (DIS) and dissemination in time (DIT) are two hallmarks of the accurate diagnosis of MS.
- DIT can be demonstrated by:
- New lesions on a follow-up MRI when compared to a baseline scan
- New clinical relapse
- Presence of oligoclonal bands in CSF
- DIS is established by:
- Noting at least one T2 lesion in two of the four following CNS sites:
- Spinal cord
- Infratentorial
- Juxtacortical
- Periventricular regions
- Noting at least one T2 lesion in two of the four following CNS sites:
Investigations
- MRI brain and spinal cord with contrast
- CSF analysis
- Evoked potentials (could be done)
- Blood studies:
- CBC
- TSH
- Vitamin B12
- Sedimentation rate
- ANA
MRI Findings
- Lesions are T2 hyperintense (white)
- Lesions are T1 isointense/hypointense
- Lesions are classically oval
- Lesions have a high predilection for periventricular white matter
- Lesions are perpendicular to the ependymal surface (Dawson's fingers)
- Contrast enhancement with active lesions noted as classically diffuse or rim enhancement
- Cord lesions classically involve the cervical or thoracic cord
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Description
Learn about multiple sclerosis, an autoimmune disease of the central nervous system characterized by chronic inflammation, demyelination, gliosis, and neuronal loss. Understand the relapsing-remitting or progressive nature of the disease along with lesions occurring at different times and locations in the central nervous system.
