Multiple Sclerosis
Introduction
Multiple sclerosis is a CNS demyelination process that leads to multiple motor, sensory and visual disturbances. There are three subtypes and they include: relapsing and remitting (responsible for 90% of cases), relapsing and progressive and chronically progressive. It is estimated that in 2015, some 2.3 million people were affected globally.
Pathophysiology
MS is an autoimmune condition. MS specifically involves the loss of oligodendrocytes, which are the cells that maintain the myelin sheath. As a result of the loss of these cells, the neuron loses its protective fatty layer and is unable to effectively conduct electrical signals to the synapse. The precise trigger that initiates the body’s attack on its myelin sheath, is unclear, but speculated to be multifactorial, involving genetics, environmental and infectious agents.
Signs and Symptoms
MS is characterized by a number of seemingly disconnected neurological findings including but not limited to focal decreased strength, tone, hyperreflexia, decreased sensation, changes in gait or vision loss.
Diagnosis
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The diagnosis is suggested by two or more of the above neurological findings.
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MRI: diffuse white matter lesions
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Spinal tap: elevated CSF protein
Treatment and Management
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For MS exacerbations, obtain a head CT to rule out other causes of new neurological findings.
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High dose steroids may be considered in consultation with a neurologist for acute MS exacerbations.
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Depending on the severity of the flare, these patients may be admitted for high dose steroids or if they have good outpatient neurology followup, may be discharged with strict return precautions.
References
Tintinalli’s 7th edition. Chapter 1447: Chronic neurologic disorders.
