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Flashcards in Diagnosis of MS Deck (26):

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..



what are the three subtypes of MS?

Relapsing-remitting (85% at onset)
Circa 80% subsequently go on to Secondary


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:

1. Typically unilateral
2. Retrobulbar
3. Typically painful
4. Some recovery expected
5. No retinal exudates
6. No macular star
7. Disc hemorrhages infrequent


Myelitis in MS is:

1. Partial sensory or motor
2. Sensory more common
3. Lhermitte sign
4. Bowel and bladder dysfunction is common
5. “Band-like” abdominal or chest pressure
6. Acute dystonias


what are 5 common brainstem/cerebrum features of MS

1. Ocular motor syndromes (e.g., internuclear ophthalmoparesis/nystagmus)
2. Hemisensory, crossed sensory syndromes
3. Hemiparesis
4. Trigeminal neuralgia
5. 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

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:

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:

behcet Dz and various other diseases


what is the risk factor for subsequent MS in clinically isolated syndrome of Optic Myelitis



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