By Charles M. Poser
This illustrated pocketbook provides an simply available precis of key concerns when it comes to diagnosing a number of sclerosis and coping with sufferers at various levels of the disease.
summary: This illustrated pocketbook provides an simply obtainable precis of key concerns in relation to diagnosing a number of sclerosis and handling sufferers at diverse phases of the illness
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Extra info for An illustrated pocketbook of multiple sclerosis
They will be discussed later. Because they emphasize MRI, which is not readily available in many parts of the world, a simplified version of the 1983 scheme is reproduced in Table 2. , 1983, with permission) AN ILLUSTRATED POCKETBOOK OF MULTIPLE SCLEROSIS 39 previously have caused signs or symptoms. Such lesions must be at locations different from those recorded by history or examination Remission: a definite improvement, lasting for at least a month Laboratory support: this applies only to the examination of CSF for an increased level of immunoglobulin G (IgG) and the presence of oligo clonal bands (see CSF below) The newMSdiagnostic criteria of McDonald The explosion in the availability and use of MRI has made almost mandatory the inclusion of imaging criteria.
This phenomenon is relatively uncommon 58 AN ILLUSTRATED POCKETBOOK OF MULTIPLE SCLEROSIS Figure 38 Sagittal proton density MRI of the spinal cord shows a completely extruded disk compressing the cord at the level of T7–8. Note the areas of increased signal intensity extending both above and below the site of compression. There is also cord compression at the T9–10 level. The patient had suffered from a fall around 2 months previously AN ILLUSTRATED POCKETBOOK OF MULTIPLE SCLEROSIS 59 Figure 39 Axial (left) and sagittal (right) T2-weighted MRIs show severe spondylosis at C4–5 with cord compression.
The often-used term ‘burden of disease’, based on the number and size of ‘lesions’, is misleading, as very large AISIs may be seen which have persisted for years in clinically normal subjects. Attempts to establish reliable MRI diagnostic criteria have largely been unsuccessful, because the pattern and characteristics of images associated with MS are also seen in many other diseases. There are no MRI patterns of ‘lesions’, including the ovoid periventricular lesion, which are essential or even diagnostic of MS.