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CME Objective: To review current evidence for diagnosis and treatment of multiple sclerosis.
Funding Source: American College of Physicians.
Disclosures: Dr. Harrison, ACP Contributing Author, has disclosed the following conflicts of interest: Personal fees: MedImmune, Questcor; Grants: Bayer Neurosciences, Merck-Serono. Disclosures can also be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M14-0547.
Editors' Disclosures: Christine Laine, MD, MPH, Editor in Chief, reports that she has no financial relationships or interests to disclose. Darren B. Taichman, MD, PhD, Executive Deputy Editor, reports that he has no financial relationships or interests to disclose. Cynthia D. Mulrow, MD, MSc, Senior Deputy Editor, reports that she has no relationships or interests to disclose. Deborah Cotton, MD, MPH, Deputy Editor, reports that she has no financial relationships or interest to disclose. Jaya K. Rao, MD, MHS, Deputy Editor, reports that she has stock holdings/options in Eli Lilly and Pfizer. Sankey V. Williams, MD, Deputy Editor, reports that he has no financial relationships or interests to disclose. Catharine B. Stack, PhD, MS, Deputy Editor for Statistics, reports that she has stock holdings in Pfizer.
With the assistance of additional physician writers, Annals of Internal Medicine editors develop In the Clinic using resources of the American College of Physicians, including ACP Smart Medicine and MKSAP (Medical Knowledge and Self-Assessment Program).
Multiple sclerosis (MS) is an autoimmune condition that results in inflammatory damage to the central nervous system (CNS). The pathologic hallmarks of MS are diffuse and focal areas of inflammation, demyelination, gliosis, and neuronal injury in the optic nerves, brain, and spinal cord. In addition to affecting white matter tracts, MS results in injury to the cortical and deep gray matter. The neurologic symptoms and disability that patients with MS experience are a direct consequence of these pathologic processes, resulting in acute and chronic disruption of white matter tracts and gray matter structures.
Examples of lesion locations emphasized by the McDonald criteria. The left image shows a sagittal, fluid-attenuated, inversion recovery brain sequence showing periventricular (top arrow), juxtacortical (right-hand arrow), and infratentorial (bottom arrow) lesions. The center image is a sagittal T1 image after administration of intravenous contrast. Lesions are typically either silent or dark on T1 imaging, but lesions that enhance with contrast (arrow) do so because of active inflammation in the lesion. The image on the right is a sagittal T2 scan of the cervical spine showing a lesion at approximately the C2 level (arrow).
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Clinical Slide Set. Multiple Sclerosis
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