eMedicine Specialties > Physical Medicine and Rehabilitation > Medical Diseases

Multiple Sclerosis: Multimedia

Author: Denise I Campagnolo, MD, MS, Director of Multiple Sclerosis Clinical Research and Staff Physiatrist, Barrow Neurology Clinics, St Joseph's Hospital and Medical Center; Investigator for Barrow Neurology Clinics; Director, NARCOMS Project for Consortium of MS Centers
Coauthor(s): Timothy Lee Vollmer, MD, Van Denburgh Chair, Barrow Neurological Institute, Division of Neurology, Director of Neuroimmunology Program, St Joseph's Hospital and Medical Center; Fu-Dong Shi, MD, PhD, Director of Neuroimmunology Laboratory, Barrow Neurological Institute, St Joseph's Hospital and Medical Center; Daniel D Scott, MD, MA, BS, Associate Professor, Department of Physical Medicine and Rehabilitation, University of Colorado at Denver and Health Sciences Center; Sandra F Williamson, MS, ANP-C, CRRN, Clinic Coordinator, Department of Rehabilitation Medicine, Denver Veterans Affairs Medical Center
Contributor Information and Disclosures

Updated: Jul 17, 2009

Multimedia

Demyelination in multiple sclerosis. Luxol fast b...
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Media file 1: Demyelination in multiple sclerosis. Luxol fast blue (LFB)/periodic acid-Schiff (PAS) stain confers an intense blue to myelin. Loss of myelin is demonstrated in this chronic plaque (lighter blue area at top right). Note that absence of inflammation may be demonstrated at the edge of chronic lesions.
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Demyelination in multiple sclerosis. Luxol fast b...

Demyelination in multiple sclerosis. Luxol fast blue (LFB)/periodic acid-Schiff (PAS) stain confers an intense blue to myelin. Loss of myelin is demonstrated in this chronic plaque (lighter blue area at top right). Note that absence of inflammation may be demonstrated at the edge of chronic lesions.

Inflammation in multiple sclerosis. Hematoxylin a...
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Media file 2: Inflammation in multiple sclerosis. Hematoxylin and eosin (H&E) stain shows perivascular infiltration of inflammatory cells. These infiltrates are composed of activated T cells, B cells, and macrophages.
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Inflammation in multiple sclerosis. Hematoxylin a...

Inflammation in multiple sclerosis. Hematoxylin and eosin (H&E) stain shows perivascular infiltration of inflammatory cells. These infiltrates are composed of activated T cells, B cells, and macrophages.

Multiple areas of increased fluid-attenuated inve...
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Media file 3: Multiple areas of increased fluid-attenuated inversion recovery (FLAIR) signal in a periventricular pattern suggesting Dawson fingers.
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Multiple areas of increased fluid-attenuated inve...

Multiple areas of increased fluid-attenuated inversion recovery (FLAIR) signal in a periventricular pattern suggesting Dawson fingers.

Same patient as in Image 3. Gadolinium contrast s...
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Media file 4: Same patient as in Image 3. Gadolinium contrast shows enhancement of the left frontal lesion, suggesting active demyelination.
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Same patient as in Image 3. Gadolinium contrast s...

Same patient as in Image 3. Gadolinium contrast shows enhancement of the left frontal lesion, suggesting active demyelination.

Magnetic resonance imaging (MRI) scan showing mul...
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Media file 5: Magnetic resonance imaging (MRI) scan showing multiple areas of increased T2 signal.
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Magnetic resonance imaging (MRI) scan showing mul...

Magnetic resonance imaging (MRI) scan showing multiple areas of increased T2 signal.

Same patient as in Image 5; no phase wrap with po...
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Media file 6: Same patient as in Image 5; no phase wrap with postgadolinium contrast. These lesions enhance in a ringlike fashion. This is typical of tumefactive multiple sclerosis.
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Same patient as in Image 5; no phase wrap with po...

Same patient as in Image 5; no phase wrap with postgadolinium contrast. These lesions enhance in a ringlike fashion. This is typical of tumefactive multiple sclerosis.

More on Multiple Sclerosis

Overview: Multiple Sclerosis
Differential Diagnoses & Workup: Multiple Sclerosis
Treatment & Medication: Multiple Sclerosis
Follow-up: Multiple Sclerosis
Multimedia: Multiple Sclerosis
References
Further Reading
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References

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  2. Frohman EM, Racke MK, Raine CS. Multiple sclerosis--the plaque and its pathogenesis. N Engl J Med. Mar 2 2006;354(9):942-55. [Medline].

  3. Kurtzke JF. Rating neurologic impairment in multiple sclerosis: an expanded disability status scale (EDSS). Neurology. Nov 1983;33(11):1444-52. [Medline].

  4. [Best Evidence] Sormani MP, Tintore M, Rovaris M, et al. Will Rogers phenomenon in multiple sclerosis. Ann Neurol. Oct 2008;64(4):428-33. [Medline].

  5. Selkirk SM, Shi J. Relapsing-remitting tumefactive multiple sclerosis. Mult Scler. Dec 2005;11(6):731-4. [Medline].

  6. [Best Evidence] Nicholas RS, Friede T, Hollis S, et al. Anticholinergics for urinary symptoms in multiple sclerosis. Cochrane Database Syst Rev. Jan 21 2009;CD004193. [Medline].

  7. [Best Evidence] Rojas JI, Romano M, Ciapponi A, et al. Interferon beta for primary progressive multiple sclerosis. Cochrane Database Syst Rev. Jan 21 2009;CD006643. [Medline].

  8. [Best Evidence] Goodman AD, Brown TR, Krupp LB, et al. Sustained-release oral fampridine in multiple sclerosis: a randomised, double-blind, controlled trial. Lancet. Feb 28 2009;373(9665):732-8. [Medline].

  9. [Best Evidence] Havrdova E, Galetta S, Hutchinson M, et al. Effect of natalizumab on clinical and radiological disease activity in multiple sclerosis: a retrospective analysis of the Natalizumab Safety and Efficacy in Relapsing-Remitting Multiple Sclerosis (AFFIRM) study. Lancet Neurol. Mar 2009;8(3):254-60. [Medline].

  10. Cutter NC, Scott DD, Johnson JC, et al. Gabapentin effect on spasticity in multiple sclerosis: a placebo- controlled, randomized trial. Arch Phys Med Rehabil. Feb 2000;81(2):164-9. [Medline].

  11. European Study Group on interferon beta-1b in secondary progressive MS. Placebo-controlled multicentre randomised trial of interferon beta-1b in treatment of secondary progressive multiple sclerosis. Lancet. Nov 7 1998;352(9139):1491-7. [Medline].

  12. Goodkin DE, Rudick RA, VanderBrug Medendorp S, et al. Low-dose (7.5 mg) oral methotrexate reduces the rate of progression in chronic progressive multiple sclerosis. Ann Neurol. Jan 1995;37(1):30-40. [Medline].

  13. Halper J, Holland NJ. Comprehensive nursing care in multiple sclerosis. New York, NY:. Demos Vermande;1997:chap 2, 5.

  14. Lechtenberg R. Multiple Sclerosis Fact Book. 2nd ed. Philadelphia, Pa:. FA Davis Co;1995:29-66.

  15. Miller AE. Diagnosis, classification and prognosis. Multiple sclerosis: clinical issues and decisions. Paper presented at: Western Regional Conference. February 1996.

  16. Paty DW, Noseworthy JH, Ebers GC. Multiple Sclerosis. Philadelphia, Pa:. FA Davis Co;1998:48-134.

  17. Rice GP, Filippi M, Comi G. Cladribine and progressive MS: clinical and MRI outcomes of a multicenter controlled trial. Cladribine MRI Study Group. Neurology. Mar 14 2000;54(5):1145-55. [Medline].

  18. Schapiro RT. Symptom Management in Multiple Sclerosis. 3rd ed. New York, NY: Demos Medical Publishing;. 1998:25-124.

  19. Scheinberg LC, Holland NJ. Multiple Sclerosis: A Guide for Patients and Their Families. 2nd ed. Lippincott Raven;1996:147-176.

  20. Simon JH. From enhancing lesions to brain atrophy in relapsing MS. J Neuroimmunol. Jul 1 1999;98(1):7-15. [Medline].

  21. Talbot PJ, Paquette JS, Ciurli C, et al. Myelin basic protein and human coronavirus 229E cross-reactive T cells in multiple sclerosis. Ann Neurol. Feb 1996;39(2):233-40. [Medline].

  22. The Canadian Cooperative Multiple Sclerosis Study Group. The Canadian cooperative trial of cyclophosphamide and plasma exchange in progressive multiple sclerosis. Lancet. Feb 23 1991;337(8739):441-6. [Medline].

  23. Trapp BD, Peterson J, Ransohoff RM, et al. Axonal transection in the lesions of multiple sclerosis. N Engl J Med. Jan 29 1998;338(5):278-85. [Medline]. [Full Text].

  24. Trapp BD, Ransohoff RM, Fisher E. Neurodegeneration in multiple sclerosis: relationship to neurological disability. Neuroscientist. 1999;5(1):48-57.

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Further Reading

Related eMedicine topics:
Acute Disseminated Encephalomyelitis
Brain, Multiple Sclerosis
Diffuse Sclerosis
Mental Disorders Secondary to General Medical Conditions
Multiple Sclerosis [Emergency Medicine]
Multiple Sclerosis [Neurology]
Multiple Sclerosis [Ophthalmology]
Multiple Sclerosis, Spine
Optic Neuritis
Optic Neuritis, Adult
Optic Neuritis, Childhood
Spasticity [Neurology]
Spasticity [Physical Medicine and Rehabilitation]

Clinical guidelines:
Assessment: the use of natalizumab (Tysabri) for the treatment of multiple sclerosis (an evidence-based review). Report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology. American Academy of Neurology - Medical Specialty Society.  2008 Sep 2.  8 pages.  NGC:006705

Disease modifying therapies in multiple sclerosis: report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology and the MS Council for Clinical Practice Guidelines. American Academy of Neurology - Medical Specialty Society
Multiple Sclerosis Council - Disease Specific Society.  2002 Jan 22 (reviewed 2003 Oct).  10 pages.  NGC:003144

EFNS guideline on treatment of multiple sclerosis relapses: report of an EFNS task force on treatment of multiple sclerosis relapses. European Federation of Neurological Societies - Medical Specialty Society.  2005 Dec.  8 pages.  NGC:005169

Natalizumab for the treatment of adults with highly active relapsing-remitting multiple sclerosis. National Institute for Health and Clinical Excellence (NICE) - National Government Agency [Non-U.S.].  2007 Aug.  21 pages.  NGC:005899

The utility of MRI in suspected MS: report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology and the Practice Committee of the Child Neurology Society. American Academy of Neurology - Medical Specialty Society
Child Neurology Society - Medical Specialty Society.  2003 Sep 9.  10 pages.  NGC:003154

Clinical trials:
A Safety Study of Combination Treatment With Avonex and Placebo-Controlled Dosing of Topamax in Relapsing-Remitting Multiple Sclerosis

Gene Expression Profiles in Multiple Sclerosis (MS)

Safety/Effectiveness of Adding Monthly Dexamethasone to Weekly Avonex for MS

Study to Evaluate Intravenous and Oral Steroids for Multiple Sclerosis Attacks

Trial of Memantine for Cognitive Impairment in Multiple Sclerosis

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Keywords

multiple sclerosis, sclerosis, MS symptoms, MS Society, multiple sclerosis symptoms, demyelinating, demyelination, multiple sclerosis treatment, multiple sclerosis diagnosis, multiple sclerosis pain, multiple sclerosis MRI, multiple sclerosis therapy, multiple sclerosis research, MS early symptoms, disseminated sclerosis, insular sclerosis, Marburg's disease, Balo's concentric sclerosis

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Contributor Information and Disclosures

Author

Denise I Campagnolo, MD, MS, Director of Multiple Sclerosis Clinical Research and Staff Physiatrist, Barrow Neurology Clinics, St Joseph's Hospital and Medical Center; Investigator for Barrow Neurology Clinics; Director, NARCOMS Project for Consortium of MS Centers
Denise I Campagnolo, MD, MS is a member of the following medical societies: Alpha Omega Alpha, American Association of Neuromuscular and Electrodiagnostic Medicine, American Paraplegia Society, Association of Academic Physiatrists, and Consortium of Multiple Sclerosis Centers
Disclosure: Teva Neuroscience Honoraria Speaking and teaching; Serono-Pfizer Honoraria Speaking and teaching; Genzyme Corporation Grant/research funds investigator; Biogen Idec Grant/research funds investigator; Genentech, Inc Grant/research funds investigator; Eli Lilly & Company Grant/research funds Novaritis; Novaritis  Novaritis; MSDx LLC Grant/research funds investigator; BioMS Technology Corp Grant/research funds investigator; Avanir Pharmaceuticals Grant/research funds investigator

Coauthor(s)

Timothy Lee Vollmer, MD, Van Denburgh Chair, Barrow Neurological Institute, Division of Neurology, Director of Neuroimmunology Program, St Joseph's Hospital and Medical Center
Timothy Lee Vollmer, MD is a member of the following medical societies: American Academy of Neurology, American Association of Immunologists, American Neurological Association, Clinical Immunology Society, and Society for Neuroscience
Disclosure: TEVA research grant and honoraria research and consulting; Biogen Consulting fee Consulting; Bayer Grant/research funds research; Serono Consulting fee Consulting; Genentech Grant/research funds research

Fu-Dong Shi, MD, PhD, Director of Neuroimmunology Laboratory, Barrow Neurological Institute, St Joseph's Hospital and Medical Center
Disclosure: Nothing to disclose.

Daniel D Scott, MD, MA, BS, Associate Professor, Department of Physical Medicine and Rehabilitation, University of Colorado at Denver and Health Sciences Center
Daniel D Scott, MD, MA, BS is a member of the following medical societies: Alpha Omega Alpha, American Academy of Physical Medicine and Rehabilitation, American Association of Neuromuscular and Electrodiagnostic Medicine, American Paraplegia Society, Association of Academic Physiatrists, National Multiple Sclerosis Society, and Physiatric Association of Spine, Sports and Occupational Rehabilitation
Disclosure: Nothing to disclose.

Sandra F Williamson, MS, ANP-C, CRRN, Clinic Coordinator, Department of Rehabilitation Medicine, Denver Veterans Affairs Medical Center
Sandra F Williamson, MS, ANP-C, CRRN is a member of the following medical societies: Phi Beta Kappa, Phi Kappa Phi, and Sigma Theta Tau International
Disclosure: Nothing to disclose.

Medical Editor

Martin K Childers, DO, PhD, Associate Professor, Department of Neurology, Wake Forest University Health Services
Martin K Childers, DO, PhD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, American Congress of Rehabilitation Medicine, American Osteopathic Association, Christian Medical & Dental Society, and Federation of American Societies for Experimental Biology
Disclosure: Allergan pharma Consulting fee Consulting

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Richard Salcido, MD, Chairman, Erdman Professor of Rehabilitation, Department of Physical Medicine and Rehabilitation, University of Pennsylvania School of Medicine
Richard Salcido, MD is a member of the following medical societies: American Academy of Pain Medicine, American Academy of Physical Medicine and Rehabilitation, American College of Physician Executives, American Medical Association, and American Paraplegia Society
Disclosure: Nothing to disclose.

CME Editor

Kelly L Allen, MD, Regional Medical Director, IMX-Medical Management Services
Disclosure: Nothing to disclose.

Chief Editor

Consuelo T Lorenzo, MD, Consulting Staff, Department of Physical Medicine and Rehabilitation, Alegent Health Care, Immanuel Rehabilitation Center
Consuelo T Lorenzo, MD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation
Disclosure: Nothing to disclose.

 
 
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