Protocolo diagnóstico del paciente con sospecha de enfermedad desmielinizante

Abstract

Multiple sclerosis (MS) is the most common autoimmune inflammatory disease of the central nervous system and is pathologically characterized by multifocal areas of demyelination with loss of oligodendrocytes, glial scarring and axonal damage in more advanced stages. MS is a very common cause of disability in young people. Although there are atypical presentations, the clinical diagnosis is relatively simple in young patients with typical onset symptoms (such as optic neuritis, brainstem syndrome and incomplete transverse myelitis) and demyelinating lesions observed in the magnetic resonance imaging that meet the dissemination criteria in time and space. The diagnosis of MS can be reached with the first clinical flare-up according to the revised 2017 McDonald criteria, in the absence of another more plausible aetiology. A cerebrospinal fluid study can help determine this disease's inflammatory nature by demonstrating intrathecal synthesis and the presence of oligoclonal bands of IgG, considered a diagnostic criterion in the primary progressive forms of MS and a dissemination criterion in time in a first clinical flare-up.