b. There is no clinical progression between the relapse episodes.
c. Usual initial presentation of 85%-90% with MS 2. Secondary progressive (SP-MS) a. Usually initiates with RR-MS, followed by deterioration or progression of the disease b. Clinical progression noted between relapsing episodes c. Patients usually do not return to baseline after relapsing episode. 3. Primary progressive (PP-MS) a. Continued disease progression from the initial neurologic episode b. Some plateaus and minor temporary improvements c. Most commonly occurs in patients with onset after 40 years of age d. Occurs in about 10%—15% of MS patients 4. Progressive relapsing (PR-MS) a. Progressive disease from the onset with clear relapses after onset b. Recovery from the relapses may be full or partial. c. Continued progression of the disease between relapses d. Neurological status does not return to baseline after the relapse e. Occurs in about 5% of MS patients 5. Malignant MS a. Very rapid onset and progressive deterioration b. Significant disability and death with short period of time 6. Benign MS a. No deterioration after 10 years following onset of disease b. Unable to predict, identified only in historical review of the patient’s disease process B. Subjective neurological symptom that lasts at least 24 hr, resulting in increased disability 1. Motor weakness, spasticity, or stiffness 2. Sensory alterations of numbness, burning, tingling, tightness, and pain 3. Brain stem symptoms of double vision, dysarthria, dysphasia, dysphagia, and vertigo 4. Visual deficits: field defect, decreased acuity, impaired color perception, and pain with eye movement 5. Cerebellar symptoms: gait ataxia, intention tremor, and uncoordinated movements 6. Cognitive dysfunction: short-term memory, slowed processing, and difficulty with higher level problem solving 7. Fatigue: overall fatigue and limb fatigue a. Present in 90% of patients 8. Sleep disorders 9. Bladder, bowel, and sexual dysfunction a. Bladder urgency, frequency, and incontinence b. Frequent UTIs c. Constipation d. Erectile dysfunction 10. Seizure 11. Tonic spasms C. Objective examination findings 1. Sensory track disturbances, present in 20%- 50% of patients a. Decreased vibratory sense b. Decreased position sense c. Decreased pinprick perception d. Decreased temperature sensation 2. Reflex alterations a. Abnormal deep tendon reflexes b. Positive Babinski sign
c. Positive Hoffman sign d. Spastic limb weakness 3. Brain stem alterations a. Nystagmus b. Hearing loss c. Tinnitus 4. Cerebellar a. Ataxia b. Tremor c. Lack of coordination 5. Visual facial a. Optic neuritis (initial symptom in 25% of patients) b. Optic disk pallor c. Pupil defect d. Visual field defect e. Trigeminal neuralgia 6. Frontal lobe a. Cognitive dysfunction b. Emotional lability or disinhibition IV. Laboratory findings/diagnostics A. Complete neurological exam with noted deficits B. MRI 1. Demonstrates white mater lesions in brain 2. Demonstrates lesions in spinal cord 3. Demonstrates T2-weighted lesions in periventricular white matter of brain and spinal cord 4. Gadolinium enhancement on T1 imaging 5. Hypodensities (black holes) on T1 imaging 6. Cerebral atrophy C. Cerebrospinal fluid (CSF) analysis
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- Fall '17
- keisha lovence