Multiple sclerosis

Introduction
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By Anthony T Reder MD

Multiple sclerosis is also known as or subsumes Disseminated sclerosis. -ed.

Multiple sclerosis affects every part of the neuraxis and has replaced syphilis as the great mimicker in neurology. Dr. Reder of the University of Chicago describes the entire spectrum of multiple sclerosis signs and symptoms, focal and diffuse brain lesions, look-alike diseases, the overactive immune response, the complex pathology of demyelination, death and dysfunction of oligodendroglia and neurons, MRI and CSF abnormalities, and the treatment of symptoms and course of multiple sclerosis. This revision includes new comments on vitamin D and the immunology, pathology, and benefits and dangers of treatment of multiple sclerosis.

Key Points

  • Multiple sclerosis is caused by immune attack against brain cells.
  • The primary damage is oligodendroglia destruction and demyelination, but axons and neurons are also damaged.
  • The incidence of multiple sclerosis is increasing around the world.
  • Multiple sclerosis lesions cause focal neurologic deficits. Problems with fatigue, cognition, and bladder control are common, but often overlooked.
  • Diagnosis is complex and requires neurologic history, clinical and MRI exam, and sometimes spinal fluid analysis.
  • New therapies have dramatically changed the course of multiple sclerosis and survival, but all therapies are still only partially effective.

In This Article

Introduction
Historical note and nomenclature
Clinical manifestations
Clinical vignette
Etiology
Pathogenesis and pathophysiology
Epidemiology
Prevention
Differential diagnosis
Diagnostic workup
Prognosis and complications
Management
Pregnancy
Anesthesia
References cited
Contributors