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Clinical and radiological characteristics of multiple sclerosis

Author: Anonymous From: www.yourpaper.net Posted: 2010-01-31 17:49:22 Read:
Author: Sun Chunying, Wang Qingtao, Zang Yingzhuo
the [Abstract] Objective To investigate the clinical features and imaging findings of multiple sclerosis (MS). Methods of collecting nine cases of MS patients clinical data and CT and MRI imaging results were analyzed retrospectively. Optic nerve symptoms (44.4%), spinal cord symptoms in 3 cases (33.3%), symptoms of cerebral hemisphere in 3 cases (33.3%), and 1 case of the brainstem symptoms of peripheral nerve symptoms. 9 patients, CT examination, six cases of abnormal, MRI examination were positive findings. Conclusions with clinical and CT, MRI performance, can improve the accuracy of the diagnosis of MS.
[keywords] Multiple Sclerosis; clinical characteristics; imaging
Multiple sclerosis (multiple sclerosis, MS) is a demyelinating disease of the central nervous system, and its cause is not yet clear. MS detection rate increasing in recent years with advances in medical standards. January 2002 - May the hospital nine cases, clinical and imaging features now analyze the report are as follows.
1 clinical data
9 1.1 General Information The group of MS patients, according to the Poser et al [1] proposed diagnostic criteria, all clinically diagnosed cases, 3 males and 6 females. The age of onset is 20 to 51 years, with an average of 32.5 years. Acute or subacute onset cases (77.8%), 2 cases of chronic onset, accounting for 22.2%. Two cases onset after a cold, I no obvious incentive.
1.2 first symptom of vision decline in three cases, two cases of diplopia, dizziness and vomiting four cases, five cases of numbness weakness, ataxia 1 cases, the urine will be obstacles one cases, epilepsy 1 cases .
1.3 neurological symptoms and signs of optic nerve symptoms four cases (44.4%), visual impairment, optic atrophy; spinal cord symptoms in 3 cases (33.3%) showed paraplegia and quadriplegia, segmental sensory disturbance and cramps; brainstem symptoms symptoms of cerebral hemisphere in 3 cases (33.3%) showed hemiplegia, hemisensory disorders, central face, tongue paralysis, seizures, aphasia and positive pathologic; showed diplopia, nystagmus, dysarthria, dysphagia, and vertigo; cerebellar symptoms one cases, showed ataxia; peripheral nerve symptoms in 1 case, the performance of the lower limbs tendon reflexes with sock-like feel abnormal.
1.4 (1) nine cases of laboratory examinations underwent brain CT examination, six patients with abnormal (66.6%); (2) 9 patients underwent brain MRI examination, all abnormal (100%) . Periventricular, brainstem, spinal cord white matter punctate or patchy long T1 and T2 images, lesions in two or more. Enhanced scan strengthen the seven cases; (3) CSF: underwent lumbar puncture, including seven cases of normal routine biochemical and two cases of slightly elevated white blood cell count, 5 routine IgG index check, three cases increased; (4) visual (VEP ), brainstem (BAEP) and somatosensory (SEP) evoked potentials check: check the 6 cases, respectively 3 cases, 2 cases, 1 case of abnormal volatility latency mainly. Clinical positioning optic nerve damage and more abnormal VEP, brainstem damage and more abnormal BAEP, spinal cord damage and more abnormal SEP.
1.5 treatment and efficacy of all patients with acute impact of conventional hormone therapy: methylprednisolone 1 g / d, instead of Prednisone 60 of 80 mg / d after 3 d oral and tapering. Patients with chronic progressive cases large doses of gamma globulin 0.4 mg (kg - d), intravenous pulse therapy in 5 days. Acute and sub-acute phase group showed significant efficacy. Chronic progressive group also improved.
2 Discussion
MS is a white matter of the central nervous system demyelinating autoimmune disease, more common in young women, the onset of acute or subacute onset mechanism is unclear, the lesions scattered in multiple, can be expressed in the course of the disease to relapse and remission. The majority of this group of patients 20 to 40 years old, male and female incidence ratio of 1:2, and reported in the literature [2]. Therefore, the diagnosis should fully consider the characteristics of the age and sex distribution of the disease. MS clinical features of the time and space of multiple diagnostic requirements in different parts of nerve damage recurrent feature. MS is widely involving the white matter of the central nervous system, including the cerebral hemispheres, brainstem, cerebellum, spinal cord and optic nerve, also another infringement of gray matter in the brain and peripheral nerves, complex and volatile of clinical manifestations, early diagnosis is difficult. This group of patients with acute and subacute onset, accounting for 77.8%, basically the same with domestic reports [3], in line with our MS disease characteristics. Limb weakness the MS common signs and symptoms, mainly as varying degrees of paralysis, paraplegia, quadriplegia, other manifestations such as: sensory disturbances, vision loss, diplopia, nystagmus, ataxia, and other MS clinical manifestations has The diversity and complexity. The onset of symptoms is one of the features of MS, related more with spinal cord involvement. Optic nerve symptoms in this group of patients (44.4%), spinal cord symptoms, 33.3%, and full of MS is more common in the spinal cord and optic nerve involvement.
MRI diagnosis of MS is the most sensitive laboratory examinations, not only can clearly show the periventricular white matter demyelination plaques, brain stem and cerebellum, spinal cord demyelinating plaques sensitivity, clinically diagnosed MS patients MRI positive rate of> 90% [3]. MRI positive rate for this group of patients was 100%, while the CT is only 66.6%, similar to the reported in the literature. MS on MRI showed long T1, long T2 signal, intracranial lesions mainly distributed in the lateral ventricle, next to the corpus callosum, centrum semiovale, midbrain, cerebellum, showed patches of shadow round or fusion, serious visible to the degeneration of brain tissue atrophy [4]. Its long axis and the brain wall vertical tangent, spinal cord lesions showed mostly uneven in cords. The group of MS patients cranial MRI lesion distribution are concentrated in the periventricular, frontal, parietal deep white matter, which is consistent with the results of previous studies. Li et al [5] confirmed through research: T1 low signal lesions in the metabolite variation T1 low signal lesions do not represent the final stage of the disease or static pathological abnormalities. Recent studies [6] confirmed extensive gray matter demyelination in MS patients with chronic process, and pathological changes of the gray matter lesions, white matter, gray matter lesions inflammatory manifestations macrophage and lymphocyte infiltration rare, and the axons transection and neuron loss is very significant. This group of patients with spinal cord MRI lesions in the cervical and thoracic spinal cord, and other literature [7] reported the same. Enhanced MRI visible lesions enhanced local BBB for active lesions. 95% lesion enhancement maintain time less than eight weeks, strengthened initially was uniform nodular, annular edge enhancement becomes after a few days to several weeks, and then after a few weeks to strengthen disappear [7]. Because this group of patients in the course of the different phases, and so the performance of a variety of forms of strengthening lesions. In conclusion, MRI has important value in the diagnosis of MS, in clinical practice, closely integrated clinical and MRI can improve the accuracy of the diagnosis of MS.
The evoked potentials check is also one of the secondary diagnosis of MS, it found that from the perspective of electrophysiological subclinical lesions. Clinical use of VEP, BAEP, SEP prompt peak latency possible changes characteristic of the disease [8]. IgG oligoclonal band of cerebrospinal fluid (CSF) is to determine the IgG intrathecal synthesis of important qualitative indicators of great value to determine IgG intrathecal synthesis. CSF IgG index is commonly used in clinical quantitative indicators, positive rate of 70% to 75% of the MS patients [9]. This group of patients positive rate is low, may be related to the primary hospital failed to timely submission related. Clinical Journal of Medical Officer (Clin J Med Offic) 2008 12 36 6
Treatment corticosteroids have a positive effect in this group of patients to obtain a certain degree of ease, and clinical observation especially methylprednisolone treatment effect. The role of hormones may reduce the inflammatory response, reducing edema and induced immunological activity of apoptosis. Immunoglobulin therapy also has a supporting role, such as stem cell transplantation is expensive, has limited application.
[1] Poser CM, Paty DW, Scheinbery L, et al.New diagnostic criteria for multiple sclerosis: guidelines for reseach protocols [J]. Ann Neurol, 1983,13 (3) :227-231.

[2] Xu Chun, Wang. Multiple sclerosis 150 cases clinical analysis [J] Chinese Journal of Psychiatry, 2004,17 (6): 337-381

[3] Huang Te-Hui, Wu Weiping, Pu Zhuanjiang. Multiple sclerosis clinical analysis of 226 cases [J] Chinese Journal of Neuroimmunology and Neurology, 2003,10 (3) :152-155.

[4] in the spring water, Kun-cheng, paragraph and so on, and so on. 182 patients with multiple sclerosis clinical and MRI analysis [J] Chinese Journal of Medical Imaging Technology, 2005,21 (5): 684-686

[5] Li BS, Regal J, Soher BJ, et al.Brain metabolite profiles of T1 hypointense lesions in relapsing remitting multiple sclerosis [J]. AJNR Am J Neuroradiol, 2003,24 (1) :68-74.

[6] Bo L, Geurts JJ, Mork SJ, et al. Grey matter pathology in multiple sclerosis [J]. Acta Neurol Scand Suppl, 2006,183 (1): 48-50.
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