-IBIS-1.5.0-
tx
nervous system
multiple sclerosis
diagnoses
definition and etiology
definition: A slowly progressive demyelinating disease of the brain and spinal cord, recognized by exacerbations and remissions of neurologic symptoms.
etiology: The cause is idiopathic; though there are theories about autoimmunity, slow viruses, and myelinic enzymes, etc., no specific mechanism has been proven. Most cases begin between 20 and 40 years old, and rarely after 50. Females are affected slightly more than males. MS seems to be a disease of temperate latitudes, in either the Northern or Southern hemispheres, and is rarely seen in equatorial regions. The characteristic lesion in MS is one of patchy demyelinization of the myelin sheaths in the CNS, particularly in the white matter.
signs and symptoms
The disease is much noted by its apparently random exacerbations and remissions. As the disease progresses, the remissions become less complete and permanent deficit is apparent. Onset is almost always insidious. Symptoms are vague and the diagnosis is often missed in the early stages.
Optic neuritis: Partial or total loss of vision in one eye with pain on moving that eye.
Diplopia and other visual disorders.
Tic doloureux in a young person.
Ataxic gait.
Tingling or tightness in the extremities and the perception of a band across one's middle.
Bladder dysfunction: Urgency, hesitancy, etc.
Depression, apathy, lack of judgment, hysteria.
Increased deep reflexes, (+) Babinski.
Charcot's triad: in advanced disease: Nystagmus, intention tremor and scanning speech.
Others specific to the individual.
lab findings: to rule-out other diseases:
CSF analysis, CT scan, brain scans, skull and spinal x-rays.
CSF IgG is increased in 70% of patients.
Agar/agarose gel electrophoresis of CSF shows discrete bands of oligoclonal proteins: 85-95% of patients.
Increased myelin basic protein: 70-90% of patients.
course and prognosis
There is no conventional cure and the course is unpredictable. Conventional physicians treat MS with corticosteroid therapy occasionally. Generally, MS patients live 30 years after diagnosis, and many can live a long time before becoming disabled.
differential diagnosis
Small cerebral infarctions.
Amyotrophic lateral sclerosis.
Syringomyelia.
Hereditary ataxias.
Pernicious anemia.
Platybasia.
Syphilis.
Arthritis of the cervical spine.
Ruptured intervertebral disks.
Spinal cord, brainstem or cerebellar tumors.
Freidrich's ataxia.
footnotes