Freedman Mark S
Department of Medicine (Neurology), University of Ottawa, Ottawa Hospital General Campus, 501 Smith Road, Box 601, Ottawa, Ontario K1H 8L6, Canada.
Mult Scler. 2004 Jun;10 Suppl 1:S31-4; discussion S34-5. doi: 10.1191/1352458504ms1028oa.
Diagnosing the 'primary progressive' form of multiple sclerosis (PPMS) requires assurance that other conditions that might cause a chronic inflammatory neurodegenerative central nervous system (CNS) disease have been ruled out. Both imaging and pathological studies have shown that this form of MS tends to be less inflammatory compared with either the relapsing-remitting or secondary progressive types. There are therefore many conditions that cause a slowly progressive wasting of the CNS that might be confused with MS. The new MS diagnostic scheme has made the presence of 'typical' MS abnormalities in the cerebrospinal fluid (CSF) a mandatory first criterion, but there may well be individuals that still have PPMS even in the absence of a typical MS CSF. Here we explore what the CSF can tell about an individual's disease process and outline the current state of the art in terms of CSF analysis. Used properly, the CSF can be very helpful in clarifying a diagnosis of PPMS.
诊断多发性硬化症（PPMS）的“原发进展型”需要确保已排除其他可能导致慢性炎症性神经退行性中枢神经系统（CNS）疾病的情况。影像学和病理学研究均表明，与复发缓解型或继发进展型相比，这种形式的多发性硬化症炎症往往较轻。因此，有许多导致中枢神经系统缓慢进行性萎缩的病症可能会与多发性硬化症混淆。新的多发性硬化症诊断方案已将脑脊液（CSF）中“典型”的多发性硬化症异常作为强制性的首要标准，但即使没有典型的多发性硬化症脑脊液，也很可能存在仍患有原发进展型多发性硬化症的个体。在此，我们探讨脑脊液能揭示个体疾病进程的哪些信息，并概述脑脊液分析的当前技术水平。如果使用得当，脑脊液对明确原发进展型多发性硬化症的诊断非常有帮助。
