Recommended diagnostic criteria for multiple sclerosis: guidelines from the International Panel on the diagnosis of multiple sclerosis

The International Panel on MS Diagnosis presents revised diagnostic criteria for multiple sclerosis (MS). The focus remains on the objective demonstration of dissemination of lesions in both time and space. Magnetic resonance imaging is integrated with dinical and other paraclinical diagnostic methods. The revised criteria facilitate the diagnosis of MS in patients with a variety of presentations, including "monosymptomatic" disease suggestive of MS, disease with a typical relapsing-remitting course, and disease with insidious progression, without clear attacks and remissions. Previously used terms such as "clinically definite" and "probable MS" are no longer recommended. The outcome of a diagnostic evaluation is either MS, "possible MS" (for those at risk for MS, but for whom diagnostic evaluation is equivocal), or "not MS."

Glomus jugulare tumor

A 53-year-old woman with left vocal cord paralysis was seen for sharp shooting pains in the left side of the neck and the left shoulder and upper arm. Glomus jugulare tumor was diagnosed, based on clinical findings and results of angiography and computed tomography. Because surgery was contraindicated, radiotherapy was used. The patient's symptoms resolved within three months, and she had had no further problems. Glomus jugulare tumor should be considered in the differential diagnosis of adult chronic otitis, deafness, tinnitus, and dysfunction of the lower cranial nerves.

Anesthesia in multiple sclerosis

The effect of general anesthesia on 42 multiple sclerosis (MS) patients who underwent 88 episodes of general anesthesia was analyzed. One patient experienced a relapse after a procedure under general anesthesia, which is compatible with the natural history of the disease. A literature review revealed little information on this subject or on the use of particular anesthetic agents in MS. Our experience with spinal and local anesthesia is reported. In the evaluation of the former our limited data suggested that spinal anesthesia is less preferable than other alternatives in MS. Local anesthetics had a benign effect on the course of MS.

The association of HLA antigens A3, B7, and DW2 with 330 multiple sclerosis patients in the United States

Reported associations of HLA antigens with MS have varied considerably. In this study we have examined 330 clinically definite MS patients from the United States. The frequency of DW2 (52%) was highly statistically significant in MS patients as compared to controls (p less than 0.00001). Neither A3 nor B7 was significantly increased in MS; however, the joint occurrences of A3-DW2 (20% vs 7%, p less than 0.001) and B7-DW2 (30% vs 13%, p less than 0.0002) are highly associated with MS.