Pita María Cecilia, Alonso Ricardo N, Cohen Leila, Garcea Orlando, Silva Berenice A
Centro Universitario de Esclerosis Múltiple, Hospital General de Agudos Dr. J.M. Ramos Mejía, Facultad de Medicina, Universidad de Buenos Aires, Buenos Aires, Argentina.
Centro Universitario de Esclerosis Múltiple, Hospital General de Agudos Dr. J.M. Ramos Mejía, Facultad de Medicina, Universidad de Buenos Aires, Buenos Aires, Argentina. E-mail:
Medicina (B Aires). 2021;81(6):972-977.
The atypical clinical features in multiple sclerosis (MS) have been rarely reported and suggest the possibility of an alternative diagnosis. The aim was to describe the clinical and demographic characteristics of MS patients who debuted with atypical symptoms and to estimate the sensitivity, specificity and positive predictive value (PPV) for MS diagnosis. A retrospective analysis of clinical records was performed. The following data were recorded: patients with MS diagnosis according to current diagnostic criteria at the time of diagnosis, type of symptom at the onset, time to second relapse, presence of oligoclonal bands (OCB) in cerebrospinal fluid (CSF) and radiological red flags on MRI. A descriptive and inferential analysis was performed using the chi square test, and sensitivity, specificity and PPV were calculated. Six hundred two patients were diagnosed with MS, of which 22 (3.65%) had an atypical clinical presentation. 54.5% were women. The mean age was 29 years (SD ± 11.7). The most common atypical symptom was peripheral facial palsy (27%). The PPV for atypical onset was 6.14%; p < 0.001. Sensitivity and specificity of these symptoms to MS diagnosis were 3.65% and 19%, respectively. In our research, the presence of atypical symptoms at the onset of MS was very low. Other diseases must be excluded, taking into account their low sensitivity, specificity and PPV.
多发性硬化症（MS）的非典型临床特征鲜有报道，提示可能存在其他诊断。本研究旨在描述首发非典型症状的MS患者的临床和人口统计学特征，并评估MS诊断的敏感性、特异性和阳性预测值（PPV）。我们对临床记录进行了回顾性分析。记录了以下数据：诊断时根据当前诊断标准确诊为MS的患者、发病时的症状类型、第二次复发时间、脑脊液（CSF）中寡克隆带（OCB）的存在情况以及MRI上的影像学警示信号。使用卡方检验进行描述性和推断性分析，并计算敏感性、特异性和PPV。602例患者被诊断为MS，其中22例（3.65%）有非典型临床表现。54.5%为女性。平均年龄为29岁（标准差±11.7）。最常见的非典型症状是周围性面瘫（27%）。非典型发病的PPV为6.14%；p<0.001。这些症状对MS诊断的敏感性和特异性分别为3.65%和19%。在我们的研究中，MS发病时非典型症状的出现率非常低。鉴于其低敏感性、特异性和PPV，必须排除其他疾病。
