Van Oosten B W, Barkhof F, Polman C H
VU Medisch Centrum, Amsterdam.
Ned Tijdschr Geneeskd. 2004 Jul 17;148(29):1417-22.
In two women, aged 29 and 49 years respectively, and a man aged 44 years, neurological signs pointed to multiple sclerosis (MS). In 2001, an international panel of experts revised the diagnostic criteria for multiple sclerosis (MS), which had been in use since 1983. As before, the fundamental diagnostic criterion remains dissemination in time and place of neurological abnormalities suggestive of demyelination. In contrast to the old criteria, the new criteria give diagnostic rules for the diagnosis of primary progressive MS. An even more important step is the further integration of MRI results in the new diagnostic criteria. This allows neurologists to diagnose MS earlier in the disease course, as was the case in the first woman: three months after the first symptoms a new MRI scan revealed dissemination in time. Recent research has shown, that MRI scans are reliable and can be used in clinical practice. If used correctly, the reliability of the diagnosis will also improve. The male patient had word-finding problems that do not fit with MS, and there were more than 9 MRI abnormalities, including juxtacortical, but no periventricular and infratentorial abnormalities. He had a vasculopathy. The second woman had dissemination in time and place, but there was a better explanation for the symptoms: neuromyelitis optica.
分别为两名年龄各为29岁和49岁的女性以及一名44岁的男性进行检查时，神经系统体征指向多发性硬化症（MS）。2001年，一个国际专家小组修订了自1983年以来一直使用的多发性硬化症（MS）诊断标准。和以前一样，基本诊断标准仍然是提示脱髓鞘的神经功能异常在时间和空间上的播散。与旧标准不同的是，新标准给出了原发性进展型MS的诊断规则。更重要的一步是将MRI结果进一步纳入新的诊断标准中。这使得神经科医生能够在病程中更早地诊断MS，就像第一名女性的情况那样：首次出现症状三个月后，一次新的MRI扫描显示了时间上的播散。最近的研究表明，MRI扫描是可靠的，可用于临床实践。如果使用正确，诊断的可靠性也会提高。男性患者存在与MS不符的找词困难问题，并且有9个以上的MRI异常，包括皮质下异常，但没有脑室周围和幕下异常。他患有血管病变。第二名女性存在时间和空间上的播散，但对这些症状有更好的解释：视神经脊髓炎。
