CSF exam
Upon examining the cerebrospinal fluid of those who have been diagnosed with multiple sclerosis, otherwise referred to as MS, electrophoretic patterns can be observed. These patterns are made up of oligoclonal bands that indicate any significant increase in the person’s IgG. In fact, roughly eighty-five percent of MS patients demonstrate this finding.
Usually, the glucose level is within normal range. However, the protein level can be either normal or mildly increased. And the white blood cells range from slightly up to moderately increased but no exceeding five, specifically the mononuclear cells.
The MBP or the myelin basic protein is an important workup in MS. This component of myelin is increased in multiple sclerosis. Still, however, physicians do not recommend using the MBP’s as the marker to indicate the disease process or the progression of multiple sclerosis.
Blood tests
Those with MS must be tested for their B12 and their Folate levels, including their antinuclear antibody, or their ANA titers. Such tests are essential whenever there is evidence of a fast-acting deterioration in the cognition or degeneration of the person’s spinal cord.
Multiple sclerotic people experiencing optic neuritis and spinal cord lesions that are somewhat extensive should go to the laboratory to be tested for NMO or neuromyelitis optica. This test will determine the presence of antibodies of aquaporin 4 flowing within the serum.
An ESR or an erythrocyte sedimentation rate must also be taken, along with positive titers of a rheumatoid factor. These specific blood tests help in identifying if the disease being experienced by the person is indeed MS or just a vasculitic disease that apes multiple sclerosis.
Imaging studies
An MRI scan of either the head or the spine, with or without gadolinium, must be performed depending on whichever location the lesions are suspected.
Lesions that appear in relation to the onset of multiple sclerosis typically appear looking like T2 hyperintensities located within periventricular areas. These typical lesions have an ovoid shape and usually affect the white matter only. In some cases, several lesions grow from the corpus callosum of the brain.
Whenever the scans indicate lesions from the corpus callosum, this is termed as Dawson fingers. This term came from the work done by James Dawson back in 1916 as a neuropathologic test at the University of Edinburgh. This kind of condition indicates that the cells associated with inflammation have been distributed perivascularly into the veins and the venules of the brain tissues.
Imaging studies can also show any formations of plaque, especially in infratentorial regions. Moreover, the most common infratentorial areas affected by the plaques are the cerebellar peduncles, the pons’ surface and also the white matter part closest to the fourth ventricle.
Once gadolinium is used as the contrast dye, some lesions become luminescent. This result is indicative of an active disease process. Such luminescence means the BBB or the blood-brain barrier has broken down because of a constant subacute process of inflammation, ranging from a few days up to several weeks.
If a combination of both luminescent and non-luminescent lesions is observed, then this would further indicate the chronicity of the disease’s demyelinating process.
With multiple sclerosis, relapses are probably the most frustration-filled area of the disease. Apart from the person with complaint having to endure such annoying and painful relapses, that person’s family and physicians are also given a hard time.
Exacerbations
Earlier on, many assumed that the returning tingling in the feet, otherwise termed as paresthesia, is an exacerbation. There are some days where this paresthesia is nearly completely gone, and in some days it just prevents the person from ambulating. Aside from this disturbance in the lower extremities, there is also the girdle-band pain that just would not go away.
With these kinds of symptoms, it is best to see a neurologist right away, especially if the symptoms are starting to interfere with normal functioning.
What is a relapse?
Relapse is the term given to an occurrence wherein the signs or symptoms are clinically significant. Such event is usually caused by lesions associated with multiple sclerosis, specifically the ones located inside the brain and spinal cord. Relapses have also been given other terms such as flares, exacerbations and attacks.
What causes a relapse?
The inflammation triggered by an immune response within the body causes the relapses. Since multiple sclerosis is an autoimmune disorder, the immune system attacks its own cells including the healthy ones. In the case of MS, the myelin sheath is attacked.
The myelin sheath serves as the protective covering of the nerves. Aside from protection, it also aids in the proper conduction of signals and messages for appropriate communication between the brain and the rest of the body.
With a damaged myelin, a lesion forms and demyelization occurs. This makes the nerves even less effective in transmitting signals properly. The symptoms associated with MS greatly depend on where the lesion is located. For example, if the lesion is located inside the cerebellum, then it will primarily cause incoordination and general imbalance. On the other hand, if the lesion has damaged the optic nerve, then the resulting symptom is a decrease in vision.
What signals a relapse?
Some relapses can be immediately observed. For example, once optic neuritis attacks, vision is lost in one eye. In other relapses, however, there are more dramatic effects such as feeling fatigued and “wobbly”.
To be definite in saying that it was a relapse, there has to be an MRI scan with a gadolinium. This is just a contrast medium used for MRI scans. It is much more observable with viewing inflammation because it tends to be luminescent whenever a certain lesion is considered active. If the lesions are active, then it means that demyelization is still taking place. When this occurs, then it is, indeed, a true relapse, and not merely symptoms of past lesions.
True relapse
For a relapse to be considered true relapse, it has to occur for at least twenty-four hours. Mini-relapses can also take place, which are mainly comprised of quirky symptoms that do not usually last for more than a couple of minutes up to a few hours only. But mini-relapses are not true relapses.
True relapses take several weeks before they stop.
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