Internal Medicine

0521779407-14 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 21:16

1016 Multiple Sclerosis

MULTIPLE SCLEROSIS

MICHAEL J. AMINOFF, MD, DSc

history & physical

■Onset typically btwn 15 & 55 years

■Weakness, sensory disturbances, ataxia, dysarthria, vertigo, sphinc-

ter disturbances, retrobulbar optic neuritis, diplopia occur alone or

in any combination

■Symptoms develop episodically, followed often by partial remission,

leading to progressive disability; sometimes progressive from onset

or after initial relapsing-remitting course

■Variable interval (sometimes of years) btwn episodes; in a few pts,

disorder is progressive from onset

■Relapses may be triggered by infection or in postpartum period

■Findings vary in different pts & at different times in the same pt

■Cognitive deficits, emotional lability, dysarthria are common

■Cranial nerve deficits include optic atrophy, nystagmus, internuclear

ophthalmoplegia, facial sensory loss

■Deficits in limbs include spasticity, pyramidal weakness, ataxia,

intention tremor, sensory loss, hyperreflexia, extensor plantar

responses

tests

■Cranial & spinal MRI reveals multiple white-matter lesions

■Cerebral evoked potentials may reveal subclinical involvement of

afferent pathways

■CSF may show mild pleocytosis, elevated IgG, oligoclonal bands

differential diagnosis

■Depends on symptoms & signs; should be evidence of multiple

lesions affecting CNS white matter & developing at different times

■If deficit can be attributed by lesion at a single site, a structural lesion

must be excluded by imaging

management

■Acute optic neuritis treated w/ IV methylprednisolone

■Acute relapses require steroids (eg, prednisone daily for 1 week, fol-

lowed by taper)