Multiple sclerosis (summary)

Dr Derek Smith et al.

Multiple sclerosis (MS) is a chronic demyelinating condition affecting the central nervous system. Diagnosis requires good history taking, clinical examination and appropriate imaging.

It is typified by "plaques" of disease which are spread by location and time. MRI is the typical imaging modality used for diagnosis and follow-up.

Reference article

This is a summary article; read more in our article on multiple sclerosis.

  • epidemiology
    • worldwide condition with strong geographical variation 1
      • overall prevalence is 30 per 100,000
    • the average of onset is 29 years
      • cases recognised from teens to over-60s
    • there is a strong female preponderance - M:F = 1:2-3
  • presentation
    • depends on the location of plaques
      • sensory or motor disturbance
      • cranial nerve involvement, e.g. optic neuritis, trigeminal neuralgia
    • classification
      • clinically isolated syndrome (CIS); isolated neurological deficit with a solitary plaque on imaging; progression to MS is not certain
      • relapsing-remitting (RRMS); 70% of cases; on-off periods of symptoms with a full resolution in between flares
      • secondary progressive (SPMS); progression of symptoms in RRMS with the deterioration of baseline functioning
      • primary progressive (PPMS); progressive deterioration from diagnosis; little or no remission
  • pathophysiology
    • white matter demyelination
      • visible on MRI as plaques of disease
    • damage to the myelin sheath surrounding axons
      • little or no underlying neuronal damage
      • likely autoimmune, cellular-mediated condition
    • no unifying cause or trigger
      • some genetic and environmental factors 3
  • investigation
    • CT may be performed because of focal neurology but is insensitive
    • MRI is the investigation of choice
      • should be performed with contrast and include the spine
  • treatment
    • managed by neurologists in specialist centres
    • treatment is focused on slowing progression
      • disease-modifying agents and steroids may be used
    • multi-disciplinary team involvement is important
    • huge psychological burden
  • initial diagnosis
  • determine degree of involvement, e.g. spine
  • follow up of plaques
CT

CT is not very specific in investigating MS but some patients may have this first-line. Appearances can be normal but large or active plaques may be visible.

MRI

The preferred imaging method is MRI for diagnosis and follow-up. The lesions are best imaged with T2 or FLAIR sequences (a method to remove the signal from fluid and allow peripheral or periventricular lesions to be more easily seen).

When the lesions are periventricular, they tend to extend perpendicularly and on sagittal views are called "Dawson's fingers" (case 1). Lesions may occur throughout the CNS and be found in a variety of locations, e.g. juxtacortical, brainstem, cerebellum or spinal cord (also part of the CNS).

If contrast is used, enhancement is a marker of activity and can be used to determine lesion load and disease progression (case 4).

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Article information

rID: 33173
Synonyms or Alternate Spellings:
  • MS (summary)

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Cases and figures

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    Case 1: "Dawson's fingers"
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    Case 2: intracranial MS
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    Case 3: T1 black holes
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    Images at (roughl...
    Case 4: composite with contrast enhancement
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