Multiple Sclerosis (MS) and Inflammatory Disorders of the CNS​

Spinal cord injuries are complex injuries that involve damage to the neural tissue within the spinal canal. Spinal cord injuries are commonly the result of trauma. Clinical presentation varies depending on the site of injury and on whether the injury is complete or incomplete. Diagnosis is by clinical exam and imaging. Management is 2-fold, with immediate supportive care and stabilization of spine followed by long-term rehabilitation with physiotherapy and treatment of complications. Spinal cord injuries are associated with multisystem complications.

Acute disseminated encephalomyelitis (ADEM) is an immune-mediated, inflammatory, monophasic, demyelinating condition that affects the white matter of the brain and spinal cord. As a rapidly progressive post-infectious encephalomyelitis, ADEM is characterized by demyelination in the brain and spinal cord as a result of inflammation following infection or immunization.

Cerebellar disorders are a specific set of neurologic signs and symptoms caused by local or systemic conditions that affect the cerebellum; the classic sign is ataxia, in addition to several other motor abnormalities that affect coordination. The causes of cerebellar disorders range from acute alcohol intoxication to inherited conditions. Clinical presentation is with incoordination of voluntary muscle movement, affected ocular movements, speech, gait, balance, and muscle tone. The diagnosis is initially made clinically and then followed by imaging studies to determine the etiology; management depends on the specific etiology.

Magnetic resonance imaging is a technique that utilizes magnetic fields and radiofrequency pulses to produce highly detailed images of the human anatomy. Magnetic resonance imaging can detect minute changes, reliably delineate lesions, and characterize vascular malformations. Soft tissues, such as abnormalities affecting non-bony structures, can be evaluated using MRI. Images can be obtained in most planes (commonly used are sagittal, coronal, and axial). Contrary to CT, MRI does not expose patients to ionizing radiation. There are some limitations of this imaging modality: MRI is expensive, time consuming, and not readily available in some centers. Additionally, patients with ferromagnetic implants or devices cannot be exposed to the MRI equipment, which has magnets. Contrast studies may result in renal complications; thus, the determination of renal function is necessary before using certain contrast agents.

Multiple sclerosis (MS) is a chronic inflammatory autoimmune disease that leads to demyelination of the nerves in the CNS. Young women are more predominantly affected by this most common demyelinating condition. The etiology of MS is unclear; however, both genetic and environmental factors are believed to play a role. The clinical presentation varies widely depending on the site of lesions, but typically includes neurological symptoms that affect vision, motor functions, sensation, and autonomic function. The diagnosis is made via MRI of the entire CNS (brain and spine) as well as CSF examination. Management involves corticosteroids for acute exacerbations and disease-modifying agents to reduce these exacerbations and slow disease progression. The average life expectancy of individuals with MS is decreased by 5–10 years.

Computed tomography (CT) is one of the most commonly used imaging methods because it is widely available, fast, and reliable. CT scans deploy X-rays to obtain cross-sectional images of the body. A CT scanner consists of a tube that rotates around the patient and emits an X-ray beam and a detector that uses specialized software to receive and convert the beam to an image. The ability to create multiple views (axial, sagittal, coronal) and use contrast (intravenous, oral, rectal) allows for enhanced diagnostic yield. Patients are exposed to radiation, and special consideration should be given to patients with a history of iodine allergy, renal disease, or thyroid disease or patients who are pregnant.

Systemic lupus erythematosus (SLE) is a chronic autoimmune, inflammatory condition that causes immune-complex deposition in organs, resulting in systemic manifestations. Women, particularly those of African American descent, are more commonly affected. The clinical presentation can vary greatly. Notable clinical features include malar rash, nondestructive arthritis, lupus nephritis, serositis, cytopenia, thromboembolic disease, seizures, and/or psychosis. Diagnosis is based on clinical criteria, and includes tests to determine ANAs, SLE-specific antibodies, and specific clinical findings. The goal of management is to control symptoms and prevent organ damage, using corticosteroids, hydroxychloroquine, and immunosuppressants.

Rheumatoid arthritis (RA) is a symmetric, inflammatory polyarthritis and chronic, progressive, autoimmune disorder. Presentation occurs most commonly in middle-aged women with joint swelling, pain, and morning stiffness (often in the hands). Systemic inflammation can lead to extraarticular manifestations such as rheumatoid nodules, interstitial lung disease, Felty syndrome, and pericarditis. Prolonged and severe disease can lead to irreversible joint deformities. Diagnosis is based on strong clinical suspicion and confirmed by the presence of rheumatoid factor (RF), anti-cyclic citrullinated peptide (anti-CCP) antibodies, and characteristic imaging. Management involves long-term disease-modifying antirheumatic drugs (DMARDs), biologic agents, and physical therapy. Glucocorticoids and nonsteroidal antiinflammatory drugs (NSAIDs) are the treatment of choice for acute exacerbation.

Sjögren syndrome (SS) is an autoimmune, inflammatory condition where glandular tissues, such as the salivary and lacrimal glands, are infiltrated by lymphocytes, resulting in decreased tear and saliva production. The disease mainly affects middle-aged women, and is associated with other autoimmune conditions. Patients may experience symptoms and complications related to dry eyes and mouth. There is a wide range of extraglandular manifestations, including Raynaud's phenomenon, neuropathy, and cutaneous vasculitis. Patients are also at an increased risk of developing non-Hodgkin's lymphoma. Diagnosis is based on the presence of symptoms, and is validated by the clinical examination, serologic studies, or salivary gland biopsy. A multidisciplinary approach is needed to manage patients and targets symptomatic relief, with immunosuppressive therapy reserved for severe symptoms.