Fact-sheet: Multiple sclerosis

Updated on 03/20/2025 at 4:14 PM

Note : 0/10

Definition

Most common chronic inflammatory demyelinating disease.

Affects all myelinated areas of the central nervous system: optic nerves, periventricular areas, corpus callosum, cerebellum, spinal cord...

Epidemiology:

Varied clinical manifestations, initially monosymptomatic (60% of cases) and related to the demyelinated area, appearing subacutely:

Motor signs: monoparesis, hemiparesis, paraparesis
Optic neuritis: visual acuity loss, periorbital pain, scotoma, red-green dyschromatopsia
Sensory disturbances: anesthesia, hypoesthesia, paresthesias, neuropathic pain
Cerebellar syndrome
Cranial nerve involvement
Bladder and sphincter dysfunction
Cognitive impairment...

Evolves according to several patterns:

Relapsing-remitting: successive relapses separated by periods of clinical stability or recovery
Progressive (primary or secondary): progressive disability without identifiable clinical relapse (typically: gait disturbances with progressive reduction of walking distance associated with cognitive and bladder/sphincter dysfunction)

Diagnosis: based on dissemination in space and time

- Dissemination in time:

Several relapses separated by symptom-free intervals: clinical, paraclinical, or anamnestic
Presence of oligoclonal bands in the CSF (revised 2017 McDonald criteria)

- Dissemination in space: involvement of at least 2 areas of the central nervous system among:

Lumbar puncture: detection of oligoclonal bands in the CSF

White matter hyperintensities on T2-weighted sequences. Sometimes associated with T1 hypointensity in the case of a "black hole", which is rarer (and reflects a highly inflammatory history of this lesion)
Predominantly periventricular, with long axis perpendicular to the ventricles
Most common cause of optic neuritis
Recent lesions (less than 3 months old) enhance after contrast administration
Main features of a tumefactive inflammatory lesion: lesion >2 cm that may raise suspicion of a brain tumor on MRI.
Little or no mass effect or edema (contrasting with the size of the lesion++).
Incomplete peripheral "open-ring" enhancement of the lesion.
Center of the lesion: hyperintense on T2/hypointense on T1 with increased ADC
Periphery of the lesion: hypointense on T2 with decreased ADC.
Mildly to moderately increased CBV (typically no hyperperfusion).
More often supratentorial location (frontal +++, parietal +).
History of demyelinating disease, prior lesions++.
However, the imaging appearance of these lesions remains highly variable: infiltrative pseudocystic lesion, infiltrative lesion, target-like (cockade) lesion.

Treatment of relapse:

High-dose corticosteroid therapy (IV or PO) at 1 gram per day for 3 days (or 5 days by consensus in the case of a spinal cord relapse)
If ineffective, plasma exchange may be considered

Disease-modifying therapies:

Symptomatic treatments

Any systemic inflammatory disease: sarcoidosis, Behçet's disease, SLE, Sjögren's syndrome, arteritis, ...

Diagnosis of tumefactive inflammatory lesions