Salah Raida Ben, Cherif Yosra, Frikha Faten, Chifaa Dammak, Snoussi Mouna, Jallouli Moez, Marzouk Sameh, Chokri Mhiri, Bahloul Zouhir
Department of Internal Medicine, Hedi Chaker University Hospital, Sfax-Tunisie.
Department of Neurology, Habib Bourguiba University Hospital, Sfax-Tunisie.
Caspian J Intern Med. 2017 Fall;8(4):321-328. doi: 10.22088/cjim.8.4.321.
Multiple sclerosis and other demyelinating processes are sometimes difficult to differentiate from the neurological involvement in autoimmune diseases. Distinguishing multiple sclerosis from other lesions due to autoimmune diseases is crucial to avoid unsuitable or delayed treatments.
Charts of 6 patients diagnosed with mimicking multiple sclerosis between 1996 and 2014 were retrospectively assessed.
The mean age at diagnosis was 35±7 years. The most commonly neurological manifestation at onset was paraparesis due to transverse myelopathy and uni/bilateral optic neuropathy. All our patients suffered from recurrent episodes of optic neuritis with a mean lag time of 12 months. Other initial presenting neurological manifestations in our patients included ataxic gait and pyramidal syndrome. Systemic symptoms occurred a long time before or after their initial neurological presentation. All patients had numerous T2 hyperintense lesions in the periventricular white matter and spinal cord with contrast enhancement. The antibodies tests revealed the presence of significant amounts of anti-nuclear antibodies. The anti-phospholipid antibodies were negative in all patients. All patients were treated with corticosteroid therapy and neurological features were cleared in all cases.
Multiple sclerosis, other myelitis and optic neuritis, are sometimes difficult to differentiate from CNS involvement in autoimmune disease. Indeed, the clinical presentation, immunological profile and MRI lesions may be similar.
多发性硬化症和其他脱髓鞘疾病有时难以与自身免疫性疾病的神经系统受累相区分。将多发性硬化症与自身免疫性疾病引起的其他病变区分开来对于避免不适当或延迟的治疗至关重要。
回顾性评估了1996年至2014年间6例被诊断为疑似多发性硬化症患者的病历。
诊断时的平均年龄为35±7岁。发病时最常见的神经学表现是横贯性脊髓病导致的双下肢轻瘫和单/双侧视神经病变。所有患者均患有复发性视神经炎，平均间隔时间为12个月。我们患者的其他初始神经学表现包括共济失调步态和锥体束征。全身症状在其初始神经学表现之前或之后很长时间出现。所有患者在脑室周围白质和脊髓中有大量T2高信号病变并伴有强化。抗体检测显示存在大量抗核抗体。所有患者的抗磷脂抗体均为阴性。所有患者均接受了皮质类固醇治疗，所有病例的神经学特征均已消除。
多发性硬化症、其他脊髓炎和视神经炎有时难以与自身免疫性疾病的中枢神经系统受累相区分。事实上，临床表现、免疫学特征和MRI病变可能相似。
