Table 1 Typical and atypical (“Red Flags”) characteristics in multiple sclerosis
From: Multiple sclerosis: molecular pathogenesis and therapeutic intervention
Feature | Typical MS characteristics | Atypical (“red flags”) characteristics |
|---|---|---|
Clinical | Subacute onset Unilateral optic neuritis Incomplete spinal cord syndrome Internuclear ophthalmoplegia | Hyperacute or chronic onset Bilateral severe optic neuritis Complete transverse myelitis Encephalopathy, headache Persistent nausea, vomiting or hiccups Prominent ophthalmoplegia |
MRI | Oval-shaped lesions Periventricular (Dawson’s fingers) Inferotemporal location Juxtacortical involving U-fibers Partial myelitis Central vein sign Chronic “black holes”, slowly expanding lesions (SELs) Nodular or “open-ring” enhancement | Large tumefactive, ill-defined lesions Longitudinally extensive spinal cord lesions (≥3 vertebral segments) Prominent cortical involvement Leptomeningeal enhancement, persistent enhancement |
CSF | CSF-restricted oligoclonal bands, elevated KFLC, and elevated IgG index Mild lymphocytic pleocytosis | Marked pleocytosis (> 50 cells/mm3), polymorphonuclear predominance Significantly elevated proteins Hypoglycorrhachia Absence or transient CSF-restricted oligoclonal bands |
