Diagnosis of MS Flashcards
Multiple Sclerosis is:
An inflammatory demyelinating disease of the CNS where there is:
Dissemination in space
Dissemination in time
No alternative neurological disease which may explain the symptoms and signs (“no better explanation”)
the diagnosis of MS is..
clinical
what are the three subtypes of MS?
Relapsing-remitting (85% at onset)
Circa 80% subsequently go on to Secondary
Progressive
Primary progressive (10%)
Progressive Relapsing (5%)
what are three commonest initial presentations of MS
optic nerve inflammation 14-20%
Weakness (10-40) Sensory Loss (13-39)
optic neuritis in MS is:
- Typically unilateral
- Retrobulbar
- Typically painful
- Some recovery expected
- No retinal exudates
- No macular star
- Disc hemorrhages infrequent
Myelitis in MS is:
- Partial sensory or motor
- Sensory more common
- Lhermitte sign
- Bowel and bladder dysfunction is common
- “Band-like” abdominal or chest pressure
- Acute dystonias
what are 5 common brainstem/cerebrum features of MS
- Ocular motor syndromes (e.g., internuclear ophthalmoparesis/nystagmus)
- Hemisensory, crossed sensory syndromes
- Hemiparesis
- Trigeminal neuralgia
- Hemifacial spasm
all diagnostic criteria for MS require…
‘dissemination in time and space’ (& ‘no better explanation
what are the four types of MS in the poser diagnostic criteria?
Clinically definite MS
Lab supported definite MS
Clinically probable MS
Lab Supported probable MS
what defines clinically definite MS in the poser criteria?
either a) 2 attacks + 2 lesions on examination
OR
2 attacks + 1 lesion + 1 paraclinical lesion
what defines laboratory supported definite MS?
B1) 2 attacks + 2 lesions on examination,
B2) 1 attack +2 lesions on examination +abnormal CSF
B3) 1 attack +1 lesion on examination + l paraclinical lesion + abnormal CSF
what supports clinically probably MS in the poser criteria?
C1) 2 attacks + 1 lesion on examination
C2) 1 attack + 2 lesions on examination
C3) 1 attack + 1 lesion on examination +1 paraclinical lesion
what supports lab supported probable MS in the poser criteria
D1) 2 Attacks + abnormal CSF
the McDonald criteria 2001: lesions must meet at least 3 of the 4 following stringent MRI criteria:
1) at least 1 Gd lesion, or at least 9 T2 lesions
2) at least one infratentorial lesion
3) at least one juxtacortical lesion
4) at least 3 periventricular lesions
what both criteria must be met for MRI +CSF criteria in McDonald (2001)
> 2 lesions consistent with MS
CSF showing OCB or increased IgG index
what are the McDonald criteria for dissemination in time (2001)
If MRI is >3 months after first event:
> 1 Gd lesion not at site of original attack; or
MRI 3 months later showing a new T2 or Gd lesion
if MRI is <3 months
New Gd lesion on the second MRI
Later MRI showing new T2 or Gd lesion
DIS (Dissemination in Space) can be established by what i the 2010 McDonald criteria?
> 1 t2 lesion at least 2 of 4 areas of the CNS:
periventricular
juxtacortical
infratentorial
spinal cord
DIT dissemination in time can be established by what criteria on McDonald 2010
1) a new T2 and/or Gd enhancing lesion(s) on follow up MRI
2) simultaneous presence of asymptomatic Gd enhancing and non-enhancing lesions at any time
CSF OCB are not….
Specific to MS:
lupus
sarcoidosis
behcet Dz and various other diseases
what is the risk factor for subsequent MS in clinically isolated syndrome of Optic Myelitis
60-80%
what are the risk factors for conversion from CIS to MS in optic myelitis
History of minor neurological symptoms Unilateral optic neuritis Brain MRI lesions Abnormal CSF Abnormal VERs
what are the risk factors for conversion from CIS to MS for transverse myelitis
Incomplete transverse myelitis Asymmetric motor or sensory findings Brain MRI lesions Abnormal CSF Abnormal VER and SSEPs
what are two differential diagnosis for MS
Neuromyelitis Optica (Devic Syndrome)
Postinfectious encephalomyelitis or ADEM
what are the qualities of neuromyelitis optica?
Relapsing (65%), monophasic (35%)
Myelitis & optic neuritis usually severe
MRI: long cord lesions, chiasmal signal changes
CSF: generally >100 wbc, increased protein, rare OCB
what are the qualities of Postinfectious encephalomyelitis or ADEM
Monophasic with preceeding event common (70%)
Most common in children
Altered level of consciousness and seizures common
MRI: bilateral lesions of the same age
what are the red flags for Misdiagnosing MS
MRI changes without symptoms or signs typical for MS
Known psychiatric disease
Normal neurological examination
Atypical clinical features
- Disease onset at the extremes of age
- Extraneural systemic disease
- Prominent gray matter symptoms
