Clinical Diagnosis

The diagnosis of MS is clinically based, relying heavily on the neurologic history and physical examination. The diagnosis is suggested when a patient has either two or more prolonged (days to weeks) episodes with neurologic dysfunction that suggests distinct white matter pathology or spinal cord dysfunction that worsens over several months.11 Optic findings, lack of focal pathology, clinical remissions, cerebrospinal fluid (CSF) findings, and typical features such as dysautonomias all suggest the diagnosis of MS.12 Symptoms that mimic MS are seen with systemic lupus erythematosus (SLE), Lyme disease, neurosyphilis, and HIV disease. The clinical features of these other diseases, as well as the presence of consistent laboratory and neuroimaging findings in MS, can help to confirm the diagnosis of MS.

Nearly all MS patients will demonstrate some CNS pathology using magnetic resonance imaging (MRI). T2-weighted scans demonstrate either discrete lesions in the supratentorial white matter or homogeneous borders surrounding the ventricles. Although computed tomography (CT) is not as sensitive as MRI, it may show cerebral atrophy, ventricular enlargement, and low-density focal lesions in the cerebrum, brainstem, or optic nerves.

CSF protein and gamma-globulin concentrations are elevated in many MS patients. A slight increase in CSF white blood cells (up to 25/hpf) is also seen, most of which are T lymphocytes. Evoked potentials (EP) demonstrate scattered slowing in CNS pathway conduction in the majority of MS patients.

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