Palavra Filipe, Tur Carmen, Tintoré Mar, Rovira Àlex, Montalban Xavier
Neurology-Neuroimmunology Department. Multiple Sclerosis Centre of Catalonia. Vall d'Hebron University Hospital. Barcelona. Spain.
Radiology Department. Magnetic Resonance Unit. Vall d'Hebron University Hospital. Barcelona. Spain.
Acta Med Port. 2014 May-Jun;27(3):393-6. doi: 10.20344/amp.4322. Epub 2014 Jun 30.
Multiple sclerosis is an inflammatory demyelinating disorder of the central nervous system. Its presentation is variable and its course and prognosis are unpredictable. Approximately 85% of individuals present a relapsing-remitting form of the disease, but some patients may evolve into a progressive course, accumulating irreversible neurological disability, defining its secondary progressive phase. Despite all the advances that had been reached in terms of diagnosis, many decisions are still taken based only on pure clinical skills. We present the case of a patient that, after being diagnosed with a clinically isolated syndrome many years ago, seemed to be entering in a secondary progressive course, developing a clinical picture dominated by a progressive gait disturbance. Nevertheless, multiple sclerosis heterogeneity asks for some clinical expertise, in order to exclude all other possible causes for patients' complaints. Here we present an important red flag in the differential diagnosis of secondary progressive multiple sclerosis.
多发性硬化是一种中枢神经系统的炎性脱髓鞘疾病。其表现多样，病程和预后难以预测。约85%的患者呈现复发缓解型疾病，但部分患者可能会进展为进行性病程，累积不可逆的神经功能残疾，进入继发进展期。尽管在诊断方面已取得诸多进展，但许多决策仍仅基于纯粹的临床技能做出。我们报告一例患者，该患者多年前被诊断为临床孤立综合征，似乎正进入继发进展期，出现以进行性步态障碍为主的临床表现。然而，多发性硬化的异质性需要一定的临床专业知识，以排除患者主诉的所有其他可能病因。在此我们展示继发进展型多发性硬化鉴别诊断中的一个重要警示信号。
