Nilsson P, Sandberg-Wollheim M, Norrving B, Larsson E-M
Department of Neurology, Clinical Sciences Lund, Lund University, Sweden.
Eur J Neurol. 2007 Nov;14(11):1292-5. doi: 10.1111/j.1468-1331.2007.01932.x. Epub 2007 Aug 31.
The clinical applicability of the revised McDonald diagnostic criteria of primary progressive multiple sclerosis (PPMS) was assessed in 17 patients with a longstanding PPMS diagnosis (mean 15 years). All patients were re-evaluated with clinical examinations, magnetic resonance imaging (MRI) of the brain and the spinal cord, extensive laboratory tests, and 12 patients underwent cerebrospinal fluid (CSF) examination. No diagnosis more likely than PPMS was disclosed. All patients had brain and spinal cord lesions on MRI. In 15 patients the brain lesions and in 14 the spinal cord lesions fulfilled the revised McDonald criteria for positive scans. No contrast-enhancing lesion was observed despite administration of triple doses of gadolinium. In total, 12 patients fulfilled the revised McDonald MRI criteria for PPMS. Of the remaining five patients who incompletely fulfilled the revised MRI criteria, all had CSF findings supporting the diagnosis PPMS. Thus, CSF analysis was required in addition to MRI in about one-third of the patients to establish the diagnosis of PPMS.
对17例长期诊断为原发性进展型多发性硬化症（PPMS）的患者（平均病程15年）评估了修订后的麦克唐纳诊断标准的临床适用性。所有患者均接受了临床检查、脑和脊髓的磁共振成像（MRI）、广泛的实验室检查，12例患者接受了脑脊液（CSF）检查。未发现比PPMS更可能的诊断。所有患者的MRI均显示脑和脊髓病变。15例患者的脑病变和14例患者的脊髓病变符合修订后的麦克唐纳阳性扫描标准。尽管给予了三倍剂量的钆，仍未观察到强化病变。总共有12例患者符合修订后的PPMS的麦克唐纳MRI标准。其余5例未完全符合修订后的MRI标准的患者，其脑脊液检查结果均支持PPMS的诊断。因此，约三分之一的患者除了MRI外还需要进行脑脊液分析以确诊PPMS。
