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Multiple Sclerosis, Emergency Medicine

Richard S. Krause Reviewed 06/2017
 


Basics

Description

  • Pathophysiology: Recurrent episodes of CNS demyelination:

    • Signs and symptoms depend on location of lesions and timing of demyelination

  • Multiple sclerosis (MS) occurs in distinct patter...

Diagnosis

Signs and Symptoms

  • Initial attacks usually (∼85%) represent single lesions, are abrupt in onset, and are seen in characteristic patterns (in order of decreasing frequency):

    • Optic neuritis:

      • Eye ...

Treatment

Initial Stabilization/Therapy

Fever in MS patients is treated aggressively because it can worsen the manifestations of MS 

Ed Treatment/Procedures

  • Acute optic neuritis:

    • High-dose parenteral ster...

Follow-Up

Disposition

Admission Criteria

  • Acute exacerbation that requires IV therapy

  • Patients unable to care for themselves due to severity of their illness

  • Another condition requiring inpatient treatment...

Pearls and Pitfalls

  • Signs and symptoms of MS are usually focal

  • Diffuse symptoms are rarely MS

  • Oral steroids are contraindicated

  • Treat fever in MS patients aggressively

Additional Reading

  • Balcer  LJ. Clinical practice. Optic neuritis. N Eng J Med.  2006;354:1273–1280.

  • Burton  JM, O’Connor  PW, Hohol  M, et al. Oral versus intravenous steroids for treatment of rel...

Codes

ICD9

340 Multiple sclerosis 

ICD10

G35 Multiple sclerosis 

SNOMED

  • 24700007 Multiple sclerosis (disorder)

  • 230372003 Acute relapsing multiple sclerosis (disorder)

  • 428700003 Primary progressive multiple s...

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