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Drawing of sclerotic lesions from Babinski's thesis "Etude anatomique et clinique de la sclérose en plaques", 1885. Multiple sclerosis (MS) can be pathologically defined as the presence of distributed glial scars in the central nervous system that must show dissemination in time (DIT) and in space (DIS) to be considered MS lesions.
Current standards for diagnosing multiple sclerosis (MS) are based on the 2018 revision of McDonald criteria.They rely on MRI detection (or clinical demonstration) of demyelinating lesions in the CNS, which are distributed in space (DIS) and in time (DIT).
Active and pre-active lesions appear as hyperintense areas under T2-weighted MRI. Pre-active lesion here refers to lesions localized in the normal appearing white matter, without apparent loss of myelin but nevertheless showing a variable degree of oedema, small clusters of microglial cells with enhanced major histocompatibility complex class ...
Currently the best predictor for clinical multiple sclerosis is the number of T2 lesions visualized by MRI during the CIS, but it has been proposed to complement it with MRI measures of BBB permeability [97] It is normal to evaluate diagnostic criteria against the "time to conversion to definite".
Animation showing dissemination of brain lesions in time and space as demonstrated by monthly MRI studies along a year Multiple sclerosis as seen on MRI. Multiple sclerosis is typically diagnosed based on the presenting signs and symptoms, in combination with supporting medical imaging and laboratory testing. [5]
Currently, routine clinical follow-up and MRI neuroimaging surveillance is the standard by which patients are observed. [4] While treatment of MS disease modifying therapies have been given to some individuals with RIS, the majority opt for active surveillance and the appearance of clinical symptoms before commencing treatment, [5] as treatment is considered controversial.
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