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Characterized by chronic inflammation and selective destruction of CNS myelin; peripheral nervous system is spared. Pathologically, the multifocal scarred lesions of MS are termed plaques. Etiology is thought to be autoimmune, with susceptibility determined by genetic and environmental factors. MS affects 350,000 Americans; onset is most often in early to middle adulthood, and women are affected approximately three times as often as men.


Onset may be abrupt or insidious. Some pts have symptoms that are so trivial that they may not seek medical attention for months or years. Most common are recurrent attacks of focal neurologic dysfunction, typically lasting weeks or months, and followed by variable recovery; some pts initially present with slowly progressive neurologic deterioration. Symptoms often transiently worsen with fatigue, stress, exercise, or heat. Manifestations of MS are protean but commonly include weakness and/or sensory symptoms involving a limb, visual difficulties, abnormalities of gait and coordination, urinary urgency or frequency, and abnormal fatigue. Motor involvement can present as a heavy, stiff, weak, or clumsy limb. Localized tingling, "pins and needles," and "dead" sensations are common. Optic neuritis can result in blurring of vision, especially in the central visual field, often with associated retroorbital pain accentuated by eye movement. Involvement of the brainstem may result in diplopia, nystagmus, vertigo, or facial pain, numbness, weakness, hemispasm, or myokymia (rippling muscular contractions). Ataxia, tremor, and dysarthria may reflect disease of cerebellar pathways. Lhermitte's symptom, a momentary electric shock–like sensation evoked by neck flexion, indicates disease in the cervical spinal cord. Diagnostic criteria are listed in Table 202-1; MS mimics are summarized in Table 202-2.


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