Review Question - QID 107663

This patient presents with signs and symptoms consistent with Multiple Sclerosis (MS). On lumbar puncture, oligoclonal IgG bands would be seen on electrophoresis.

MS is an inflammatory and neurodegenerative autoimmune disorder affecting the central nervous system (CNS). These CNS lesions are disseminated in time and space. Patients can present with changes in vision, sensation, muscle weakness, Lhermitte’s sign and so on. This disorder mostly affects young female adults. On MRI, multiple T2-hyperintense lesions, commonly found in the periventricular white matter, brainstem, spinal cord, and cerebellum, can be seen.

Calabresi present a review on the diagnosis and management of MS. Cerebrospinal fluid IgG concentration is increased in approximately 90% of patients with definite MS. However, this, along with the presence of oligoclonal bands, are not diagnostic of this disease because they are non-specific. Rather, obtaining a CSF may be very useful in excluding other conditions that may mimic MS, such as infection or a neoplastic process.

Gelfand discuss that diagnosis, differential diagnosis, and clinical presentation in MS. Diagnosing MS is based on demonstrating CNS injury that is of inflammatory-demyelinating nature, disseminated in both space and time. This is accomplished by obtaining a clinical history, neurologic examination, MRI, and exclusion of other processes that can imitate MS. Discrete episodes of sensory changes (numbness, tingling), vision loss, weakness, bladder dysfunction, impairment in gait, to name a few, are typical in MS.

Figure A is a MRI of a patient’s brain with MS. Note the periventricular hyperintense lesions (Dawson fingers).

Incorrect Answers:
Answer 1: 14-3-3 protein would most likely be present in Creutzfeldt-Jakob disease, a neurodegenerative disorder secondary to protease-resistant prion. proteins. Patients can present with rapid dementia and myoclonus.
Answer 2: Decreased glucose with neutrophilic predominance describes a bacterial infectious process.
Answer 4: IgG would most likely be increased in MS.
Answer 5: Albuminocytologic dissociation would be suggestive of Guillain-Barre syndrome. This is characterized by a symmetric, ascending, weakness and paralysis. Reflexes are often absent in affected areas. This syndrome is commonly associated by a preceding respiratory or gastrointestinal infection.