This document is posted to help you gain knowledge. Please leave a comment to let me know what you think about it! Share it to your friends and learn new things together.
Transcript
Supplementary digital content references
1. Okuda DT, Mowry EM, Beheshtian A, et al. Incidental MRI anomalies suggestive of multiple sclerosis: The radiologically isolated syndrome. Neurology. 2009;72(9):800-805. doi: 10.1212/01.wnl.0000335764.14513.1a.
2. Lublin FD, Reingold SC, Cohen JA, et al. Defining the clinical course of multiple sclerosis: The 2013 revisions. Neurology. 2014;83(3):278‐286. doi: 10.1212/WNL.0000000000000560 [doi].
3. Miller, D. H., Weinshenker, B. G., Filippi, M., Banwell, B. L., Cohen, J. A., Freedman, M. S., Polman, C. H. (2008). Differential diagnosis of suspected multiple sclerosis: A consensus approach. Multiple Sclerosis (Houndmills, Basingstoke, England), 14(9), 1157-1174. doi: 10.1177/1352458508096878
6. Miller DH, Leary SM. Primary-progressive multiple sclerosis. Lancet Neurol. 2007;6(10):903-912. doi: 10.1016/S1474-4422(07)70243-0.
7. Petzold A, Wattjes MP, Costello F, et al. The investigation of acute optic neuritis: A review and proposed protocol. Nat Rev Neurol. 2014;10(8):447‐458. doi: 10.1038/nrneurol.2014.108 [doi].
8. Jurynczyk M, Craner M, Palace J. Overlapping CNS inflammatory diseases: Differentiating features of NMO and MS. J NeurolNeurosurg Psychiatry. 2015;86(1):20-25. doi: 10.1136/jnnp-2014-308984 [doi].
SDC Figure Legends
Supplementary Digital Content Figure 1
Caption: The 1996 vs. 2013 multiple sclerosis phenotype descriptions for relapsing disease
Reproduced with permission from [2]: Lublin FD, Reingold SC, Cohen JA, et al. Defining the clinical course of multiple sclerosis: The 2013 revisions. Neurology. 2014;83(3):278‐286. doi: 10.1212/WNL.0000000000000560 [doi].
Supplementary Digital Content Figure 2
Caption: The 1996 vs. 2013 multiple sclerosis phenotype descriptions for progressive disease
Reproduced with permission from [2]: Lublin FD, Reingold SC, Cohen JA, et al. Defining the clinical course of multiple sclerosis: The 2013 revisions. Neurology. 2014;83(3):278‐286. doi: 10.1212/WNL.0000000000000560 [doi].
Supplementary Digital Content Figure 3
Isolated Spinal Cord Syndrome
Typical for MS - Evolution over hours to days - Partial myelitis - purely sensory - Deafferented upper limb - Lhermitte’s sign - Partial Brown-Sequard - Spontaneous remission
Atypical for MS - Hyperacuteonset or insidiously
progressive - Complete transverse or
longitudinally extensive myelitis- Sharp sensory level - Radicular pain - Areflexia - Failure to remit - Systemic symptoms such as
fever
Brain and spinal cord MRI
Low risk for MS (20%)
Normal Abnormal lesions consistent with demyelination
High risk for MS (60-90%) Review McDonald criteria
-Infection (syphilis, lyme, tuberculosis, viral including HIV, HTLV)
-Toxic/nutritional/metabolic (B12 or copper deficiency, nitrous oxide toxicity)
- Non-cord “mimics” (Guillain-Barré syndrome,
MRI, CSF neurophysiological, serologic and other studies as appropriate
Differential Diagnosis Upon Presentation with a Possible Demyelinating Spinal Cord Syndrome
MRI clearly indicates a non-MS diagnosis e.g. spinal cord compression
Consider otherdiagnoses
Differential Diagnosis Upon Presentation with a Possible Demyelinating Spinal Cord Syndrome
Reproduced with permission from[3] Miller, D. H., Weinshenker, B. G., Filippi, M., Banwell, B. L., Cohen, J. A., Freedman, M. S., . . .Polman, C. H. (2008). Differential diagnosis of suspected multiple sclerosis: A consensus approach. Multiple Sclerosis (Houndmills, Basingstoke, England), 14(9), 1157-1174. doi: 10.1177/1352458508096878
Supplementary Digital Content Figure 4
Isolated Brain Stem Syndrome
Typical for MS -internuclear ophthalmoplegia
- 6th nerve palsy
-multifocal signs e.g. facial sensory loss and vertigo or hearing loss
Atypical for MS -onset that is hyperacute or slowly progressive
-vascular territory signs e.g. lateral medullary syndrome
-age>50
- isolated trigeminal neuralgia
Brain MRI
Low risk for MS (20%)
Normal
Abnormal lesions consistent with demyelination
High risk for MS (60-90%) Review McDonald criteria
MRI, CSF, neurophysiological, serologic and other studies as appropriate
Consider other diagnoses MRI clearly
indicates a non-MS diagnosis (e.g. hemorrhage)
Differential Diagnosis Upon Presentation with a Possible Demyelinating Brain Stem Syndrome
Differential Diagnosis Upon Presentation with a Possible Demyelinating Brain Stem Syndrome
Reproduced with permission from[3]: Miller, D. H., Weinshenker, B. G., Filippi, M., Banwell, B. L., Cohen, J. A., Freedman, M. S., . . .Polman, C. H. (2008). Differential diagnosis of suspected multiple sclerosis: A consensus approach. Multiple Sclerosis (Houndmills, Basingstoke, England), 14(9), 1157-1174. doi: 10.1177/1352458508096878
Supplementary digital content table 1
Reproduced with permission from [1]: Okuda, D. T., Mowry, E. M., Beheshtian, A., Waubant, E., Baranzini, S. E., Goodin, D. S., et al. (2009). Incidental MRI anomalies suggestive of multiple sclerosis: The radiologically isolated syndrome. Neurology, 72(9), 800-805. doi:10.1212/01.wnl.0000335764.14513.1a
Supplementary Digital Content Table 2
Clinical “Red Flags”
RED FLAG EXAMPLES OF ALTERNATIVE DIAGNOSIS
“Major red flags”
Bone lesions histiocytosis; Erdheim Chester disease
Onset after age 50 cerebral infarction; amyloid angiopathy; lymphoma
Caption: Red flags are ordered from the most “major” to the most “minor” as per rankings by the Panel. Major red flags point fairly definitively to a non-MS diagnosis; minor red flags may be consistent with MS or an alternative diagnosis. Intermediate red flags are those for which there was poor agreement and uncertainty among raters about the weighting of the flag for differential diagnosis in MS, especially in isolation of other informative symptoms, signs and assays. Minor red flags suggest that a disease other than MS should be considered and fully explored, but an MS diagnosis is not excluded.
Adapted from [3, 4]: Miller, D. H., Weinshenker, B. G., Filippi, M., Banwell, B. L., Cohen, J. A., Freedman, M. S., Polman, C. H. (2008). Differential diagnosis of suspected multiple sclerosis: A consensus approach. Multiple Sclerosis (Houndmills, Basingstoke, England), 14(9), 1157‐1174. doi: 10.1177/1352458508096878 AND Katz Sand IB, Lublin FD. Diagnosis and differential diagnosis of multiple sclerosis. Continuum (MinneapMinn). 2013;19(4 Multiple Sclerosis):922‐943. doi: 10.1212/01.CON.0000433290.15468.21 [doi].
Marked asymmetry of WM lesions glioblastoma; lymphoma; cerebral infarction
Caption: Red flags are ordered from the most “major” to the most “minor” as per rankings by the Panel. Major red flags point fairly definitively to a non-MS diagnosis; minor red flags may be consistent with MS or an alternative diagnosis. Intermediate red flags are those for which
there was poor agreement and uncertainty among raters about the weighting of the flag for differential diagnosis in MS, especially in isolation of other informative symptoms, signs and assays. Minor red flags suggest that a disease other than MS should be considered and fully explored, but an MS diagnosis is not excluded.
Adapted from [3, 4] Miller, D. H., Weinshenker, B. G., Filippi, M., Banwell, B. L., Cohen, J. A., Freedman, M. S., Polman, C. H. (2008). Differential diagnosis of suspected multiple sclerosis: A consensus approach. Multiple Sclerosis (Houndmills, Basingstoke, England), 14(9), 1157‐1174. doi: 10.1177/1352458508096878 AND Katz Sand IB, Lublin FD. Diagnosis and differential diagnosis of multiple sclerosis. Continuum (MinneapMinn). 2013;19(4 Multiple Sclerosis):922‐943. doi: 10.1212/01.CON.0000433290.15468.21 [doi].
Supplementary Digital Content Table 4
Reported causes of transverse myelitis
Reproduced with permission from [5]: Beh SC, Greenberg BM, Frohman T, FrohmanEM. Transverse myelitis. NeurolClin. 2013;31(1):79-138. doi: http://dx.doi.org/10.1016/j.ncl.2012.09.008.
Supplementary digital content table 5
Differential diagnosis of progressive spastic paraparesis
Reproduced with permission from [6]: Miller DH, Leary SM. Primary-progressive multiple sclerosis. Lancet Neurol. 2007;6(10):903-912. doi: 10.1016/S1474-4422(07)70243-0.
Supplementary Digital Content Table 6
Differential diagnoses and mimics of optic neuritis
Reproduced with permission from [7]:Petzold A, Wattjes MP, Costello F, et al. The investigation of acute optic neuritis: A review and proposed protocol. Nat Rev Neurol. 2014;10(8):447‐458. doi: 10.1038/nrneurol.2014.108 [doi].
Supplementary Digital Content Table 7
Red flags implying a diagnosis other than MS-related Optic Neuritis
Reproduced with permission from [7]: Petzold A, Wattjes MP, Costello F, et al. The investigation of acute optic neuritis: A review and proposed protocol. Nat Rev Neurol. 2014;10(8):447‐458. doi: 10.1038/nrneurol.2014.108 [doi].
Supplementary Digital Content Table 8
Reproduced with permission from [8]:Jurynczyk M, Craner M, Palace J. Overlapping CNS inflammatory diseases: Differentiating features of NMO and MS. J NeurolNeurosurg Psychiatry. 2015;86(1):20‐25. doi: 10.1136/jnnp‐2014‐308984 [doi].