Multiple sclerosis for the practicing neurologist by Joel Oger; et al

By Joel Oger; et al

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Diffuse cord abnormalities are associated with spinal symptoms, high disability, and a primary progressive disease course. • Prevalence of cord abnormalities in established MS is quite high (74%–85%) and depends on the imaging method used and the group of patients. In clinically isolated syndromes, the prevalence of spinal-cord lesions is lower, especially if no spinal-cord symptoms are present (30%–40%). 11) has had a role in MS diagnosis for more than eight decades. In areas where MRI is easily accessible, the role of CSF examination has declined.

His gait is spastic, and vibration sense is absent at the ankles. His brain MRI scan shows scattered supratentorial white matter lesions with a degree of atrophy. Spinal cord imaging shows an intrinsic cord lesion just above the C5/C6 level. A degree of cervical canal narrowing also is present at the C5/C6 level. Dynamic views do not demonstrate significant instability. 4). 2) and are less likely to spare subcortical Ufibers. Ischemic lesions may show microhemorrhage on gradient echo sequences and involve deep nuclear gray matter, but a clear distinction may not be possible.

J Neurol Neurosurg Psychiatry 2005;76:ii16–ii22, with permission. 9 28 Special Investigations in Multiple Sclerosis tion must be established from a consideration of the rest of the clinical and investigative picture. Anything that impairs conduction in the retino-striate pathway is likely to give rise to abnormalities in the latency, amplitude, or waveform of the VEPs. The sensitivity of VEP to clinical disorders depends on the technique used to evoke them. Abnormal VEP, typical of MS can be used to supplement information provided by a clinical examination to provide objective evidence of a second lesion, provided that the only clinically expressed lesion did not affect the visual pathway.

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