Koska tulee epäillä MS-tautia ja kuinka se diagnosoidaan?

Hanna Kuusisto
M.D., Neurologist, Head of
Department
Kanta-Häme Central Hospital,
Department of Neurology
Suomen Lääkärilehti 7/2012 vsk 67
eNGLisH sUMMARY
When to suspect multiple sclerosis (MS) and
how to make the diagnosis?
The•first•symptomatic•episode•of•MS•is•called•clinically•isolated•syndrome•(CIS),•which•is•most•
commonly•paraparesis•due•to•myelitis,•visual•loss•and•pain•in•the•eye•due•to•optic•neuritis•(ON)•or•
diplopia•due•to•internuclear•ophthalmoplegia•(INO).•CIS•is•not•synonymous•with•MS.•However,•a•large•
proportion•of•CIS•patients•are•at•risk•of•developing•MS•within•a•few•years.•The•risk•can•be•evaluated•
using•brain•MRI•and•cerebrospinal•fluid•(CSF)•analysis.•Those•presenting•abnormalities•both•in•MRI•
and•in•CSF•are•at•very•high•risk,•whereas•those•with•normal•findings•in•CSF•and•brain•MRI•have•a•
minimal•risk•of•developing•MS.•High-risk•patients•should•be•carefully•monitored•by•repeated•brain•
MRI•in•order•to•make•the•diagnosis•as•early•as•possible.•The•diagnosis•of•MS•is•made•using•the•so•
called•McDonald’s•revisited•criteria•which•are•based•on•the•demonstration•of•dissemination•of•central•
nervous•system•demyelination•in•space•and•in•time.•The•criteria•have•recently•been•revisited.•To•make•
a•definite•diagnosis•of•relapsing•remitting•MS,•the•dissemination•of•demyelination•in•time•and•space•
can•be•detected•purely•clinically,•or•both•clinically•and•radiologically.•The•suspicion•of•CIS•should•arise•
when•a•young•adult•presents•with•myelitis,•ON•or•INO•especially•after•a•common•viral•infection.
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