Chapter 15 - Demyelinating disorders

Abstract

Multiple sclerosis (MS) is one of a large number of diseases of varied pathogenesis in which white matter of the central nervous system is focally or diffusely the main target. Its epidemiologic and genetic factors are rarely relevant in a forensic setting, which are discussed in this chapter. Clinical manifestations are quite variable in space and time, and virtually the entire spectrum of neurologic symptoms and signs can occur at different times. A clinical course of relapses and remissions with stepwise incremental progression is also a characteristic occurrence. The cerebrospinal fluid profile of mild elevation of lymphocyte count and presence of oligoclonal bands on electrophoresis is supportive, but not diagnostic of MS. Magnetic resonance imaging is an increasingly important tool in the diagnosis because of its ability to detect plaques. Plaques are rarely detected by the naked eye on the surface of the cerebral cortex, but they can be demonstrated in cortex on stained sections. Clinical manifestations are quite variable in space and time, and virtually the entire spectrum of neurologic symptoms and signs can occur at different times.