Abstract
Multipl skleroz MS tanısında ve ayırıcı tanısında bazı olgularda çeşitli güçlükler yaşanmaktadır. Klinik belirti ve bulgular yanında, manyetik rezonans görüntüleme MRG , beyin omurilik sıvısı BOS incelemesi ve uyarılmış potansiyeller tanıyı kesinleştirmek için önemlidir. Tüm bunlara rağmen bu testlerin tanısal duyarlılık ve özgüllüğü sınırlıdır. Elli yedi yaşında tavuk çiftliği işletmecisi olan erkek hasta, 35 gün önce başlayan sağ yüz yarısında uyuşma ve denge bozukluğu yakınması ile başvurdu. Sağ yüz yarısında objektif hipoestezi ve sağda Babinski bulgusu saptandı. Beyin MRG incelemesindeki; 2 cm çapında, halkasal kontrast tutulumu olan homojen lezyon öncelikle kistik bir oluşumu düşündürdü. BOS ve görsel uyarılmış potansiyel neticesinde hastanın MS olduğu anlaşıldı. Bu hastaların klinik ve nörogörüntüleme ile takibi ayırıcı tanıda değerli bilgiler sağlayabilmektedir
References
- Ropper AH. Selective treatment of multiple sclerosis. N Engl J Med 2006;354(9):965-7.
- McDonald WI, Fazekas F, Thompson AJ. Diagnosis of multiple sclerosis. Zh Nevrol Psikhiatr Im S S Korsakova 2003;2:4-9.
- Murray TJ. Diagnosis and treatment of multiple sclerosis. BMJ 2006;332:525-7.
- Anderson RC, Connolly Jr ES, Komotar RJ, et al. Clinico- pathological review: tumefactive demyelination in a 12-ye- ar-old girl. Neurosurgery 2005;56(5):1051-10576.
- Swanton JK, Fernando K, Dalton CM, et al. Modification of MRI criteria for multiple sclerosis in patients with cli- nically isolated syndromes. J Neurol Neurosurg Psychiatry, 2006;77(7):830-3.
- Polman CH, Reingold SC, Banwell B, et al. Diagnostic cri- teria for multiple sclerosis: 2010 revisions to the McDonald criteria. Ann Neurol 2011;69(2):292-302.
- Bencsik K, Rajda C, Füvesi J, et al. The prevalence of multip- le sclerosis, distribution of clinical forms of the disease and functional status of patients in Csongrad County, Hungary. Eur Neurol 2001;46(4):206-9.
- Lublin FD, Reingold SC. Defining the clinical course of multiple sclerosis: results of an international survey. Nati- onal Multiple Sclerosis Society (USA) Advisory Commit- tee on Clinical Trials of New Agents in Multiple Sclerosis. Neurology 1996; 46(4):907-11.
- Confavreux C, Vukusic S, The natural history of multiple sclerosis. Rev Prat 2006;56(12):1313-20.
- Okuda DT, Mowry EM, Beheshtian A, et al. Incidental MRI anomalies suggestive of multiple sclerosis: the radiological- ly isolated syndrome. Neurology 2009;72(9):800-5.
- Sormani MP, Bruzzi P. MRI lesions as a surrogate for re- lapses in multiple sclerosis: a meta-analysis of randomised trials. The Lancet Neurology 2013;12(7):669-76.
- Gabr RE, Hasan KM, Haque ME, et al. Optimal combina- tion of FLAIR and T2‐weighted MRI for improved lesion contrast in multiple sclerosis. Journal of Magnetic Reso- nance Imaging 2016;44(5): 1293-1300.
- Gastaldi M, Zardini E, Franciotta D. An update on the use of cerebrospinal fluid analysis as a diagnostic tool in mul- tiple sclerosis. Expert Rev Mol Diagn 2017;17(1):31-46.
- Link H, Huang YM. Oligoclonal bands in multiple sclerosis cerebrospinal fluid: an update on methodology and clinical usefulness. J Neuroimmunol 2006;180(1–2):17-28.
- Pihl-Jensen G, Schmidt MF, Frederiksen JL. Multifocal vi- sual evoked potentials in optic neuritis and multiple sclero- sis: A review. Clin Neurophysiol 2017;128(7):1234-45.
- Kamińska J, Koper OM, Piechal K, Kemona H. Multiple sc- lerosis - etiology and diagnostic potential. Postepy Hig Med Dosw 2017;71(0):551-63.
Abstract
There are several difficulties in diagnosing of multiple sclerosis MS and differential diagnosis in some cases. In addition to clinical signs and symptoms, magnetic resonance imaging MRI , cerebrospinal fluid CSF analysis and evoked potentials are important to confirm the diagnosis. Despite all these, the diagnostic sensitivity and specificity of these tests is limited. The male patient, a poultry farmer at the age of fifty-seven, applied with complaints of numbness of right facial area and balance disorder which started 35 days ago. Objective hypoesthesia in the right half of the face and Babinski finding in the right were detected. Brain MRI study; a homogeneous lesion of 2 cm in diameter with annular contrast enhancement was thought to be primarily a cystic formation. The patient was diagnosed with MS as a result of CSF and visual evoked potential. Clinical and neuroradiologic evaluation of these patients can provide valuable information on differential diagnosis
References
- Ropper AH. Selective treatment of multiple sclerosis. N Engl J Med 2006;354(9):965-7.
- McDonald WI, Fazekas F, Thompson AJ. Diagnosis of multiple sclerosis. Zh Nevrol Psikhiatr Im S S Korsakova 2003;2:4-9.
- Murray TJ. Diagnosis and treatment of multiple sclerosis. BMJ 2006;332:525-7.
- Anderson RC, Connolly Jr ES, Komotar RJ, et al. Clinico- pathological review: tumefactive demyelination in a 12-ye- ar-old girl. Neurosurgery 2005;56(5):1051-10576.
- Swanton JK, Fernando K, Dalton CM, et al. Modification of MRI criteria for multiple sclerosis in patients with cli- nically isolated syndromes. J Neurol Neurosurg Psychiatry, 2006;77(7):830-3.
- Polman CH, Reingold SC, Banwell B, et al. Diagnostic cri- teria for multiple sclerosis: 2010 revisions to the McDonald criteria. Ann Neurol 2011;69(2):292-302.
- Bencsik K, Rajda C, Füvesi J, et al. The prevalence of multip- le sclerosis, distribution of clinical forms of the disease and functional status of patients in Csongrad County, Hungary. Eur Neurol 2001;46(4):206-9.
- Lublin FD, Reingold SC. Defining the clinical course of multiple sclerosis: results of an international survey. Nati- onal Multiple Sclerosis Society (USA) Advisory Commit- tee on Clinical Trials of New Agents in Multiple Sclerosis. Neurology 1996; 46(4):907-11.
- Confavreux C, Vukusic S, The natural history of multiple sclerosis. Rev Prat 2006;56(12):1313-20.
- Okuda DT, Mowry EM, Beheshtian A, et al. Incidental MRI anomalies suggestive of multiple sclerosis: the radiological- ly isolated syndrome. Neurology 2009;72(9):800-5.
- Sormani MP, Bruzzi P. MRI lesions as a surrogate for re- lapses in multiple sclerosis: a meta-analysis of randomised trials. The Lancet Neurology 2013;12(7):669-76.
- Gabr RE, Hasan KM, Haque ME, et al. Optimal combina- tion of FLAIR and T2‐weighted MRI for improved lesion contrast in multiple sclerosis. Journal of Magnetic Reso- nance Imaging 2016;44(5): 1293-1300.
- Gastaldi M, Zardini E, Franciotta D. An update on the use of cerebrospinal fluid analysis as a diagnostic tool in mul- tiple sclerosis. Expert Rev Mol Diagn 2017;17(1):31-46.
- Link H, Huang YM. Oligoclonal bands in multiple sclerosis cerebrospinal fluid: an update on methodology and clinical usefulness. J Neuroimmunol 2006;180(1–2):17-28.
- Pihl-Jensen G, Schmidt MF, Frederiksen JL. Multifocal vi- sual evoked potentials in optic neuritis and multiple sclero- sis: A review. Clin Neurophysiol 2017;128(7):1234-45.
- Kamińska J, Koper OM, Piechal K, Kemona H. Multiple sc- lerosis - etiology and diagnostic potential. Postepy Hig Med Dosw 2017;71(0):551-63.
Details
| Primary Language | Turkish |
|---|---|
| Journal Section | Case Report |
| Authors | |
| Publication Date | March 1, 2018 |
| Published in Issue | Year 2018 Volume: 28 Issue: 2 |
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