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In the Clinic |

Multiple Sclerosis

Daniel M. Harrison, MD
Ann Intern Med. 2014;160(7):ITC4-1. doi:10.7326/0003-4819-160-7-201404010-01004
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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.

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Grahic Jump Location
Figure.

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).

Grahic Jump Location

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