Cause Of Neurological Symptoms Research Articles

Spectrum of MRI findings in central nervous system affection in Lyme neuroborreliosis

Affections of the central nervous system (CNS) rarely occur in Lyme neuroborreliosis (LNB). CNS manifestations can have residual neurological symptoms despite antibiotic treatment. We explored the spectrum of CNS affections in patients with LNB in a tertiary care center in a region endemic for Lyme borreliosis. We retrospectively included patients treated at a tertiary care center from January 2020–December 2021 fulfilling the case criteria for LNB as stated in the current German guideline on LNB. Clinical data, cerebrospinal fluid (CSF) findings and MRI imaging were collected. We included 35 patients with LNB, 24 with early manifestations and 11 with CNS-LNB. CNS-LNB patients had encephalomyelitis (n = 6) or cerebral vasculitis (n = 5). Patients with early LNB and CNS-LNB differed regarding albumin CSF/serum quotient and total protein in CSF. Duration from onset of symptoms until diagnosis was statistically significantly longer in patients with encephalomyelitis. MRI findings were heterogeneous and showed longitudinal extensive myelitis, perimedullar leptomeningeal enhancement, pontomesencephalic lesions or cerebral vasculitis. CNS-LNB can present with a variety of clinical syndromes and MRI changes. No clear pattern of MRI findings in CNS-LNB could be identified. The role of MRI consists in ruling out other causes of neurological symptoms.

Invasive Fungal Sinusitis with Intracranial Extension and Fatal Outcome: A Case Report

Invasive fungal sinusitis is a morbid condition usually encountered in patients with poor immunity, for instance, diabetics or those with lymphoproliferative disease. We report invasive fungal sinusitis in a young immunocompetent host. This case presents a 21-year-old man with an invasive fungal infection and intracranial extension. The patient initially complained of right-sided weakness, headache, vomiting, and diplopia and was subsequently found to have a significant post-contrast enhancement along the left temporal region, encasing the internal carotid artery (ICA). The patient was started on antifungal therapy, and underwent functional endoscopic sinus surgery (FESS) which revealed growth of Aspergillus on fungal culture. He later developed severe cardiac dysfunction and neurological deterioration, ultimately leading to death. This case highlights the significance of taking into account the importance of fungal sinusitis as a potential cause of neurological symptoms, particularly in younger age groups. Early diagnosis and appropriate management are crucial in preventing potentially fatal complications.

Magnetic resonance imaging for diagnosing a rare disease: incontinentia pigmenti (Bloch–Sulzberger syndrome) on the example of a clinical case

Incontinentia pigmenti, also known as BlochSulzberger syndrome, is a rare hereditary disease characterized by typical skin rashes and involvement of other organs and systems. Magnetic resonance imaging stands as the primary method for visualizing the structural pathology of the brain and predicting neurological manifestations in an affected child.
 Diagnosing incontinentia pigmenti predominantly falls within the domain of dermatologists; verification is performed by molecular genetic analysis of the IKBKG gene. This study involved magnetic resonance imaging of the brain in a patient with skin rashes, characteristic of BlochSulzberger syndrome, and deletion in the IKBKG gene, where numerous foci of ischemia, hemorrhages, and lesions of the tracts were detected.
 Magnetic resonance imaging of the brain in patients with BlochSulzberger syndrome is used to evaluate the severity of damage to the brain substance, which makes it possible to explain the cause of neurological symptoms and correct habilitation, as well as predict the development of the child.

Brain metastasis localized to the same area of infarction: illustrative case.

Ischemic stroke and tumor account for a disproportionate share of deaths and disabilities among the elderly. Patients with a tumor who develop recurrent acute neurological deficits after a stroke can be at risk for tumor-related stroke. In contrast, brain metastases (BM) are common causes of neurological symptoms and are associated with a poor prognosis in patients with both malignancy and ischemic stroke. The authors report a rare case of metastatic melanoma that manifested in the same region as a previous ischemic infarction. A 22-year-old female presented at our emergency department with right hemiparesis and sensory difficulties. Infarction in the left frontoparietal and basal ganglia regions was found on a computed tomography scan of the brain. A decompressive hemicraniectomy was performed urgently. After 16 years, a biopsy taken from her chin revealed malignant melanoma. Hemorrhagic metastasis on the frontal lobe of the brain was detected with magnetic resonance imaging and was histopathologically confirmed upon resection. In addition to recurrence, BM may be considered when a person with ischemic stroke and a cancer such as melanoma has new neurological problems in one area that cannot be explained by the stroke.

1042 Cognitive Behavioral Therapy for Insomnia (CBT-I) in Patient with Neurological Symptoms of Unclear Etiology

Abstract Introduction For those experiencing neurological symptoms and being evaluated for multiple sclerosis (MS), it is important to assess whether sleep disturbance is primary or secondary to neurological disease. In this case, CBT-I was initiated to rule out a sleep disorder as an underlying cause of neurological symptoms. Report of case(s) The patient is a 61-year-old, White, female with chronic insomnia, excessive daytime sleepiness, and mild OSA comorbid with abnormal brain MRI (significant non-specific lesions). Patient is followed by neuroimmunology for management of neurological symptoms with unclear etiology (fatigue, paresthesia, neuropathic pain, and impaired cognition). She was referred to sleep medicine by her neurologist who suspected severe fatigue and sleepiness may be contributing to complex medical presentation. Patient endorsed a history of sleep-maintenance insomnia associated with drowsy driving (1 MVA and 3 near-misses). Of note, patient discontinued CPAP use for mild OSA in spring 2022 due to device recall. Her sleep physician recommended CBT-I to increase TST prior to OSA re-evaluation. Patient presented as anxious and distressed regarding safety while driving. She initiated CBT-I and engaged in stimulus control, cognitive restructuring, sleep diaries, relaxation, motivational interviewing, and supportive therapy. Baseline sleep diaries showed average WASO=146 minutes, SE=58%, and TST=4.1 hours. At week 7, average WASO=60 minutes, SE=86%, and TST=6.0 hours. Though no baseline measure was obtained, sleep disturbance (PROMIS Sleep T Score) was WNL (T=54) at week 7. Depression, anxiety, and pain-related disability decreased: PHQ-9 (11-moderate to 8-mild), GAD-7 (6-moderate to 4-mild), PDI (41 to 33). Measures of daytime sleepiness remained in the severe range (ESS 20 to 18), suggesting the need for OSA re-evaluation. Although sleep quality improved, patient reported new and worsening neurological symptoms including dysphagia and falls at home. CBT-I treatment is ongoing. Conclusion As individuals diagnosed with MS and other neurological disorders are more likely to experience insomnia than the general population, assessment of sleep disorders and evidenced-based treatments should be part of comprehensive neurological evaluation. In this case, the patient’s sleep parameters improved with CBT-I, but neurological symptoms persisted and worsened, suggesting the need for continued assessment and follow-up with neurology and sleep physicians. Support (if any) None.

Animal Models to Study Neurologic Manifestations of COVID-19.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the cause of the worldwide coronavirus (COVID-19) pandemic, has infected an estimated 525 million people with over 6 million deaths. Although COVID-19 is primarily a respiratory disease, an escalating number of neurologic symptoms have been reported in humans. Some neurologic symptoms, such as loss of smell or taste, are mild. However, other symptoms, such as meningoencephalitis or stroke, are potentially fatal. Along with surveys and postmortem evaluations on humans, scientists worked with several animal species to try to elucidate the causes of neurologic symptoms. Neurologic sequelae remain challenging to study due to the complexity of the nervous system and difficulties in identification and quantification of neurologic signs. We reviewed animal models used in the study of neurologic COVID-19, specifically research in mice, hamsters, ferrets, and nonhuman primates. We summarized findings on the presence and pathologic effects of SARS-CoV-2 on the nervous system. Given the need to increase understanding of COVID-19 and its effects on the nervous system, scientists must strive to obtain new information from animals to reduce mortality and morbidity with neurologic complications in humans.

Metagenomic next-generation sequencing for identification of central nervous system pathogens in HIV-infected patients.

Although considerable interest in metagenomic next-generation sequencing (mNGS) has been attracted in recent years, limited data are available regarding the performance of mNGS in HIV-associated central nervous system (CNS) infection. Here, we conducted a retrospectively analyzing of the cerebrospinal fluid (CSF) mNGS reports and other clinical data from 80 HIV-infected patients admitted to the Second Hospital of Nanjing, China from March, 2018 to March, 2022. In our study, CSF mNGS reported negative result, mono-infection, and mixed infection in 8.8, 36.2, and 55% of the patients, respectively. Epstein-Barr virus (EBV), positive in 52.5% of samples, was the most commonly reported pathogen, followed by cytomegalovirus (CMV), John Cunningham virus (JCV), torque teno virus (TTV), cryptococcus neoformans (CN), toxoplasma Gondii (TE), and mycobacterium tuberculosis (MTB). 76.2% of the EBV identification and 54.2% of the CMV identification were not considered clinically important, and relative less sequence reads were reported in the clinical unimportant identifications. The clinical importance of the presence of TTV in CSF was not clear. Detection of JCV, CN, or TE was 100% suggestive of specific CNS infection, however, 60% of the MTB reports were considered contamination. Moreover, of the 44 (55%) mixed infections reported by mNGS, only 4 (5%) were considered clinical important, and mNGS failed to identify one mixed infection. Additionally, except for MTB, CSF mNGS tended to have high sensitivity to identify the above-mentioned pathogens (almost with 100% sensitivity). Even all the diagnostic strategies were evaluated, the cause of neurological symptoms remained undetermined in 6 (7.5%) patients. Overall, our results suggest that mNGS is a very sensitive tool for detecting common opportunistic CNS pathogen in HIV-infected patients, although its performance in CNS tuberculosis is unsatisfactory. EBV and CMV are commonly detected by CSF mNGS, however, the threshold of a clinical important detection remains to be defined.

Knowledge and Perception of Triple Whammy among Pharmacists in the Kingdom of Saudi Arabia

Hypoglycemia is a major cause of neurological symptoms that can become frequent in diabetic patients. Hypoglycemia usually manifests with behavioral changes, confusion, and loss of consciousness. We report a case of a 75-year-old male who developed clinical features suggestive of stroke, which improved with dextrose infusion. The presentation overlaps with cerebrovascular accident and upon onset of symptoms, immediate treatment is deemed crucial. From a primary care provider standpoint, initial patient education on medication and consistent glucose monitoring is key to long-term management prevention of such hypoglycemic episodes. The presentations also highlight the importance of hypoglycemic awareness in diabetic patients

Hypoglycemic Episode Masquerading Like Stroke: A Case Report in a Clinical Setting

Hypoglycemia is a major cause of neurological symptoms that can become frequent in diabetic patients. Hypoglycemia usually manifests with behavioral changes, confusion, and loss of consciousness. We report a case of a 75-year-old male who developed clinical features suggestive of stroke, which improved with dextrose infusion. The presentation overlaps with cerebrovascular accident and upon onset of symptoms, immediate treatment is deemed crucial. From a primary care provider standpoint, initial patient education on medication and consistent glucose monitoring is key to long-term management prevention of such hypoglycemic episodes. The presentations also highlight the importance of hypoglycemic awareness in diabetic patients.

Thyrotoxic periodic paralysis. A case report

In 19-26% of patients hospitalized with suspected stroke, the cause of neurological symptoms are not cerebrovascular diseases. In this case of newly diagnosed thyrotoxic periodic paralysis we presented the clinical, laboratory and instrumental features of the disease. The search for the cause of periodic paralysis allowed to identify an endocrinological disease - diffuse toxic goiter, prescribe antithyroid therapy. The data of prospective patient observation are presented. We discussed a differential diagnostic range of diseases with acute low paraparesis, including rupture of an aneurysm of the anterior communicating artery, bilateral infarction in territory of anterior cerebral arteries, thrombosis of upper sagittal sinus, acute spinal strokes and Guillain - Barre syndrome. The need to include thyrotoxic periodic paralysis in patients with acute lower paraparesis in the differential diagnostic series is substantiated.

Imaging, Clinical, and Demographic Differences in Patients With Type III Spinal Cerebrospinal Fluid Leak (Cerebrospinal Venous Fistulas) Compared With Patients With Types I and II Spinal Cerebrospinal Fluid Leak.

Spinal cerebrospinal fluid (CSF) leaks are an underdiagnosed cause of neurologic symptoms. The most common types of spinal CSF leaks are from dural tears (type I) and meningeal diverticula (type II). Cerebrospinal fluid-venous fistulas (type III) are less common and underrecognized. The purpose of this study was to evaluate the intracranial and spinal imaging findings in patients with types I/II versus type III leaks. This was a retrospective, institutional review board-approved study performed on adult patients between January 2020 to September 2021 with surgically confirmed type I/II/III spinal CSF leak. Patients had preoperative brain magnetic resonance imaging (MRI) with contrast and medical records detailing symptoms and clinical diagnoses. Patients were excluded for nondiagnostic brain MRIs. Demographic and clinical information were recorded. The presence of extra-axial collections, pachymeningeal thickening, brain sagging, and decreased pontomamillary distance were evaluated on MRI. Seven patients had type III leaks, and 16 had type I/II leaks. Patients with type III leaks were older ( P = 0.0003) and had higher rates of initial misdiagnosis (100% vs 31%) and longer times to correct diagnosis ( P = 0.03) compared with type I/II leaks. Intracranial extra-axial collections were never seen with type III leaks but were seen in 50% of type I/II leaks. Pachymeningeal thickening and brainstem sagging occurred in nearly equal frequency between groups. Smaller pontomamillary distances were seen in type III leaks versus type I/II leaks ( P = 0.047). When evaluating patients with suspected spinal CSF leak, findings of older age, absence of intracranial extra-axial collections, and small pontomamillary distances may raise suspicion for type III versus type I/II leak.

Encephalopathy after unintentional intrathecal gadolinium: A letter to the editor

ObjectiveRaise awareness of gadolinium encephalopathy, a rare cause of neurological symptoms. SettingAn L5-S1 interlaminar epidural steroid injection (IL-ESI) was performed with a gadolinium-based contrast agent (GBCA) due to the patient's history of allergic reaction to iodine-based contrast agents. DiscussionSeveral hours after administration of GBCA, the patient had nausea and vomiting with altered mental status. Patient was treated with dexamethasone IV, and was discharged on day 2. Patient had no residual deficits at follow-up two weeks later. Current literature shows that caution should be used to prevent inadvertent intrathecal GBCA, and doses >2.0 mmols are associated with serious adverse effects, including death. ConclusionsIntrathecal administration of GBCAs should be limited to less than 0.5 mmol. If adverse effects are experienced, IV steroids should be administered as soon as possible, and a CSF drain should be considered.

Histopathological Analysis of Central Nervous System Metastases: Six Years of Data From a Tertiary Center.

Introduction: The most common cause of neurological symptoms in patients with systemic malignant tumors is central nervous system (CNS) metastases, and CNS metastases are one of the important causes of morbidity and mortality in these patients. The most common metastatic tumors to the CNS are lung, breast, malignant melanoma, genitourinary, and gastrointestinal tumors. We aimed to analyze our data on patients with CNS metastases in our department, which belongs to a large archive in the field of neuropathology.Methods: The data of patients who had CNS metastases between January 2015 and August 2021 in our department were reviewed retrospectively. The patients were grouped in terms of demographic data, location, histopathological diagnosis, and primary origin characteristics, and their frequency and immunohistochemical staining characteristics were investigated.Results: There were 256 patients with CNS metastases in our study. The mean age was found to be 56.12. Of the patients, 30.5% were female and 69.5% were male. Astrocytic and oligodendral tumors (25.3%), followed by meningiomas (24.1%), and then CNS metastases (21.3%) were the most common CNS tumors. Among the CNS metastases, the most common primary sites were the lung (58%), breast (16%), tumors of unknown primary origin (TUP) (5%), colon (4%), and gynecologic tract (3.1%). Localization was found as cerebral (69.5%), cerebellar (28.1%), and spinal (2.3%).Conclusion: In CNS system metastases, an accurate histological diagnosis should be made by histomorphological evaluation supported by compatible immunohistochemical results in the presence of clinical history and radiological findings. Despite performing a larger immunohistochemical panel, it should be kept in mind that a primary site of origin cannot be found in a significant number of cases.

Post-mortem neuropathologic examination of a 6-case series of CAR T-cell treated patients.

Introduction: Chimeric antigen receptor (CAR) T-cell therapy is a promising immunotherapy for the treatment of refractory hematopoietic malignancies. Adverse events are common, and neurotoxicity is one of the most important. However, the physiopathology is unknown and neuropathologic information is scarce. Materials and methods: Post-mortem examination of 6 brains from patients that underwent CAR T-cell therapy from 2017 to 2022. In all cases, polymerase chain reaction (PCR) in paraffin blocks for the detection of CAR T cells was performed. Results: Two patients died of hematologic progression, while the others died of cytokine release syndrome, lung infection, encephalomyelitis, and acute liver failure. Two out of 6 presented neurological symptoms, one with extracranial malignancy progression and the other with encephalomyelitis. The neuropathology of the latter showed severe perivascular and interstitial lymphocytic infiltration, predominantly CD8+, together with a diffuse interstitial histiocytic infiltration, affecting mainly the spinal cord, midbrain, and hippocampus, and a diffuse gliosis of basal ganglia, hippocampus, and brainstem. Microbiological studies were negative for neurotropic viruses, and PCR failed to detect CAR T -cells. Another case without detectable neurological signs showed cortical and subcortical gliosis due to acute hypoxic-ischemic damage. The remaining 4 cases only showed a mild patchy gliosis and microglial activation, and CAR T cells were detected by PCR only in one of them. Conclusions: In this series of patients that died after CAR T-cell therapy, we predominantly found non-specific or minimal neuropathological changes. CAR T-cell related toxicity may not be the only cause of neurological symptoms, and the autopsy could detect additional pathological findings.

Neurological manifestations of long-COVID syndrome: a narrative review.

Accumulating evidence points toward a very high prevalence of prolonged neurological symptoms among coronavirus disease 2019 (COVID-19) survivors. To date, there are no solidified criteria for ‘long-COVID’ diagnosis. Nevertheless, ‘long-COVID’ is conceptualized as a multi-organ disorder with a wide spectrum of clinical manifestations that may be indicative of underlying pulmonary, cardiovascular, endocrine, hematologic, renal, gastrointestinal, dermatologic, immunological, psychiatric, or neurological disease. Involvement of the central or peripheral nervous system is noted in more than one-third of patients with antecedent severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, while an approximately threefold higher incidence of neurological symptoms is recorded in observational studies including patient-reported data. The most frequent neurological manifestations of ‘long-COVID’ encompass fatigue; ‘brain fog’; headache; cognitive impairment; sleep, mood, smell, or taste disorders; myalgias; sensorimotor deficits; and dysautonomia. Although very limited evidence exists to date on the pathophysiological mechanisms implicated in the manifestation of ‘long-COVID’, neuroinflammatory and oxidative stress processes are thought to prevail in propagating neurological ‘long-COVID’ sequelae. In this narrative review, we sought to present a comprehensive overview of our current understanding of clinical features, risk factors, and pathophysiological processes of neurological ‘long-COVID’ sequelae. Moreover, we propose diagnostic and therapeutic algorithms that may aid in the prompt recognition and management of underlying causes of neurological symptoms that persist beyond the resolution of acute COVID-19. Furthermore, as causal treatments for ‘long-COVID’ are currently unavailable, we propose therapeutic approaches for symptom-oriented management of neurological ‘long-COVID’ symptoms. In addition, we emphasize that collaborative research initiatives are urgently needed to expedite the development of preventive and therapeutic strategies for neurological ‘long-COVID’ sequelae.

Electrodiagnostic evaluation in differential diagnosis and neurosurgical treatment of radiculopathies caused by spine disorders. Diagnostic value and methodology

To assess the role of electromyography including paraspinal muscle mapping in diagnosis of radiculopathies following spine diseases. We have analyzed literature data in the Scopus, Pubmed, and RSCI databases and selected 93 references for primary reviewing. Final analysis enrolled the manuscripts with a detailed description of neurophysiological examinations and data on sensitivity/specificity of these methods. Needle electromyography (EMG) is the most informative neurophysiological method for diagnosis of radicular damage. Sensitivity of EMG is up to 90% for lumbosacral radiculopathy. Electromyography of the paraspinal muscles can be used in case of of cervical, thoracic and lumbar radiculopathy in addition to EMG of limb muscles. Therefore sensitivity increases to 100%. Diagnostic value of nerve conduction study (NCS) is low, and performing NCS without EMG is not useful. In neurosurgical practice electrodiagnostic (EDX) should be performed for differential diagnosis of radiculopathy and peripheral nervous system lesions, to determine the level of radicular compression, and when physical examination does not correspond with neuroimaging or MRI is not possible to perform.

Radiological Manifestation of Neurological Complications in the Course of SARS-CoV-2 Infection.

Many reports suggest the SARS-CoV-2 infection may result in neurological complications. A wide spectrum of clinical syndromes have been reported, including both central and peripheral nervous system. Such symptoms may be a consequence of a direct viral injury, secondary to systemic inflammatory response, autoimmune processes, ischemic lesions or combination of these. Anosmia and dysgeusia are highly prevalent in the early stage of infection. Cerebrovascular events in patients with COVID-19 have also been documented with increasing frequency. Some cases of parainfectious autoimmune neurologic manifestations concurrent with active SARS-CoV-2 infection have been described, including hemorrhagic necrotizing encephalopathy, Guillain-Barré and Miller-Fisher syndromes. There are also a few reports documenting encephalitis and acute demyelinating encephalomyelitis (ADEM) in the course of COVID-19. There is also a growing number of cases of patients after recovery from COVID-19 with psychosomatic disorders, manifesting with memory disfunction, cognitive functions disorders, depression or other affective disorders, which may lead to a decrease of intellectual functions. Many of these neurological manifestations of the infection are possible to distinguish using radiological imaging techniques. It plays a very important role in evaluating the course of COVID-19 as well as diagnosing respiratory complications and choosing a proper management of infected patients. Similarly, radiological techniques play crucial role in identifying the cause of neurological symptoms connected to SARS-CoV-2 infection, being one of the most important elements of diagnostics. Especially in case of the presence of nervous system implication, using radiological imaging techniques to monitor the emerging onset of various symptoms is crucial to assess the severity and scope of involvement. Quick diagnostic process and identifying complications as fast as possible in order to implement specific treatment can be crucial to avoid long-term secondary conditions and accelerate the recovery period. In this review, we present the most important neurological complications that may occur in the course of SARS-CoV-2 infection and summarize their radiological manifestations.

A Polyostotic Paget’s Disease Involving Lumbar Spine Presenting with Cauda Equina Syndrome: An Unusual Entity

Introduction:Paget’s disease of bone (PDB) is a metabolic bone disease presenting as polyostotic or monostotic lesions of the spine. Although common in the Anglo-Saxon population, it is rare on the Indian subcontinent. Neurological complications though infrequent can be severe in pagetic spine.Case Report:We report a case of a polyostotic variant of PDB involving lumbar spine (L2 vertebrae), iliac bones, and femur presenting as chronic low back pain and neurological deficit, i.e., cauda equina syndrome. On initial workup, a diagnosis of PDB was made and given cauda equina compression with neurological deficit, posterior spinal decompression, and biopsy was performed. The histopathological evaluation confirmed the diagnosis and the patient was treated with bisphosphonates for 6 months, along with serial monitoring of alkaline phosphatase levels.Conclusion:Through this case report, we hope to emphasize that PDB should be considered as a possible cause of neurological symptoms at presentation, especially in elderly patients. Also furthermore, early surgical intervention followed by bisphosphonates therapy can lead to favorable outcomes in such patients.

Idiopathic Hypertrophic Spinal Pachymeningitis: A Case Report.

Idiopathic hypertrophic pachymeningitis is rare cause of neurological symptoms with myelopathy due to spinal cord compression. We report a case of pachymeningitis, which was manifested primarily by tetraparesis after low-energy trauma and recurrence the myelopathy symptoms after 5 years of surgery. The patient, a 19-year-old woman, was subjected to extensive investigation without evidence of any underlying disease. A meningeal biopsy was performed and showed an unspecific inflammatory process with extensive fibrosis of the dura mater. These findings, associated with the exclusion of other causes, suggest idiopathic hypertrophic pachymeningitis.

Disability measurement in Multiple Sclerosis patients 55 years and older: What is the Expanded Disability Status Scale really telling clinicians?

BackgroundThe Expanded Disability Status Scale (EDSS) measures disease progression in Multiple Sclerosis (MS). EDSS changes are assumed to be due to worsening MS-related disability. Strict interpretation of this premise may include some normal findings as abnormal, inflating the disability score. Further, determining the cause of neurologic symptoms can be difficult in an older population with comorbid illness and polypharmacy. ObjectiveTo examine the association between EDSS, age, comorbidities and polypharmacy. Methods106 people, 55 years and older, with and without MS were administered the EDSS and a validated comorbidity questionnaire. Polypharmacy was also assessed. ResultsMedian EDSS scores were 6.0 in people with MS and 3.0 in people without MS. No participant in our cohort had an EDSS of 0. Higher EDSS scores were associated with older age and more polypharmacy. Pyramidal and cerebellar functional systems accounted for the largest percentage of unique variance between groups. ConclusionOlder individuals with and without MS demonstrated significant disability on the EDSS. These findings indicate that EDSS scores may be partially due to factors other than MS. Our understanding of disease course and disability may benefit from the development of normative EDSS scores to correct for these factors.