Multiple SclerosisMaking the Diagnosis.ppt

* * * * * A list of MS symptoms for diagnosing * * * * * Differntial Diagnosis in MS(Frohman E, et al Neurology, 2003) Red Flags for Misdiagnosing MS MRI changes without clinical correlate Known psychiatric disease Normal neurologic examination Atypical clinical features Disease onset at the extremes of age Extraneural systemic disease Prominent gray matter symptoms Case #1 31 year old Asian female presents with subacute onset of right sided trunk numbness (T4 level) and asymmetric leg weakness. No prior neurologic symptoms or signs. MRI of cord shows patchy upper thoracic T2- signal lesion. CSF: 100 wbc, increased protein negative OCBs. Case #2 18 year old male high school senior presents with 48 hours of blurred vision, bilateral leg weakness with right arm ataxia. He appears to be alert but is a bit slow to respond to questions. No recent illnesses or significant PMH. MRI shows bilateral brainstem, occipital and cerebellar T2-lesions some of which enhance. His family is extremely concerned and ask your opinion on his diagnosis and prognosis. Breaking the news of an MS diagnosis Communicate with the patient face-to-face Explain prognosis and treatment using lay terms Give hope to the patient by: encouraging pursuit of personal/career goals Correcting pessimistic impressions of MS Provide information on future follow-up and patient support resources MS Patient Information National MS Society Consortium of MS Centers Multiple Sclerosis Association of America Paralyzed Veterans of America VA MS Centers of Excellence (East West) /ms * * * * * I flow chart starts with the neurological evaluation and splits into 3 groups: Group 1. Findings of typical MS means MS and “treats for MS”, Group 2. Minor or Unusual Findings means MS Possible and “close follow-up /or focused work-up, Group 3. Normal Findings means MS unlikely and “reassure and evaluate when appropriate * * A diagram of the MS subtypes: relapsing-remitting, primary progressive, secondar