Tag Archives: Neurology

VA AM AMBULATORY REPORT PEARLS 10.23 – CIS and MS

From the Daily Ditty

Attached is the graphic from the 1997 NEJM Paper “Small-Vessel Vasculitis” that we discussed as a nice image to keep for your future teaching files.

Vasculitidies

From Ambulatory Report

We reviewed the sensory pathways with a couple of key learning points summarized in a table I created as follows:

  Dorsal column medial lemniscus tract Anterior spinothalamic tract
Decussation Medulla Spinal cord
Exit from spinal cord Dorsal horn to dorsal root ganglion Dorsal horn to dorsal root ganglion
Type of sensation Touch, vibration, proprioception Pain, temperature, can carry touch as well
Blood supply Two arteries – posterolateral spinal arteries One artery – anterior spinal artery

We discussed the “Clinically Isolated Syndrome” or CIS which is used to describe a first episode of neurologic symptoms. Patients with CIS may go on to develop MS.

Here are your pearls on CIS:

  • CIS = first episode of neurologic symptoms lasting at least 24 hours
  • Caused by inflammation/demyelination in one or more sites in the CNS
  • Can be single sign or symptom or more caused by lesions in multiple locations
  • If CIS is accompanied by MRI-detected brain lesions, there is a higher likelihood of a second neurologic event
  • In various studies, the likelihood of developing MS for patients with CIS + MRI lesions ranges from 60-80%. Without MRI findings, the long-term incidence is approximately 20%.
  • The most common presentations for CIS are:
    • Sensory symptoms
      • Numbness, tingling, pins-and-needles, tightness, coldness particularly of the limbs or trunk
      • Swelling of the limbs or trunk
      • Intense itching in the cervical dermatome, usually unilateral
    • Visual changes
      • Optic neuritis is the most common which presents as acute or subacute unilateral eye pain worsened with eye movement and is typically followed by visual loss
      • Diplopia
    • Motor symptoms
      • Leg weakness > arm weakness
      • Leg spasticity > arm spasticity
    • Issues with coordination
      • Gait imbalance
      • Difficulty performing coordinated actions with the arms
      • Vertigo is reported in 30-50% of MS presentations
    • Physical exam findings
      • Dysmetria
      • Hypotonia