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CONDITION/DISORDER SYNONYM

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  • Disseminated sclerosis

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ICD-9-CM CODE

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  • 340 Multiple sclerosis

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ICD-10-CM CODE

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  • G35 Multiple sclerosis

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PREFERRED PRACTICE PATTERNS

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  • 4C: Impaired Muscle Performance

  • 5E: Impaired Motor Function and Sensory Integrity Associated with Progressive Disorders of the Central Nervous System

  • 6B: Impaired Aerobic Capacity/Endurance Associated with Deconditioning

  • 6C: Impaired Ventilation, Respiration/Gas Exchange, and Aerobic Capacity/Endurance Associated with Airway Clearance Dysfunction

  • 6E: Impaired Ventilation and Respiration/Gas Exchange Associated with Ventilatory Pump Dysfunction or Failure

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PATIENT PRESENTATION

A 24-year-old graduate student was studying late at night for an examination when he realized that his left arm and left leg were numb. He dismissed the complaint, recalling that 6 or 7 months ago he had similar symptoms. He rose from his desk and noticed that he had poor balance. His vision was blurred, and remembered that he had some blurred vision approximately 1 to 2 years earlier, but that this resolved. He had not seen a physician for any of these previous symptoms. He went to bed and decided that he would seek medical consultation the next day.1

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KEY FEATURES

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Description
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  • Chronic disease

  • Progressive disorder characterized by demyelination (or demyelinating plaques) in the central nervous system attacking the brain, spinal cord, and optic nerves

  • The disease process causes areas of inflammation, lesions, in random and unpredictable areas of the central nervous system. The inflammation leads to irreversible axonal damage and scarring that interferes with nerve impulse.

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Essentials of Diagnosis
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  • Etiology is unknown2

  • Episodic neurologic symptoms

  • Usually under 55 years of age at onset.3

  • Single pathologic lesion cannot explain clinical findings.

  • Multiple foci is best visualized by MRI.

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General Considerations
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  • Diagnosis of clinically definite disease can be made when there is dissemination of symptoms in time and space.

    • Time: Any new lesion in the central nervous systems in a follow-up MRI

    • Space: One or more lesions identified in two distinct locations in the central nervous system

  • The diagnosis is probable in patients with multifocal white matter disease, but only one clinical attack.

  • Four categories of the disease

    • Relapsing/Remitting: Clearly defined relapses, or episodes of loss of function, followed by relative recovery

    • Primary progressive: Continuous decline in function, not interrupted by plateaus or periods of faster decline/relapse

    • Secondary progressive: Begins as relapsing/remitting, and later becomes slow progressive decline without periods of remittance

    • Progressive relapsing: Continuous decline with periods of faster decline/relapse, time between relapses shows progressive decline

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Demographics
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  • 90% of people with multiple sclerosis (MS) are diagnosed between the ages of 16 and 60 years; more common in women (2.5:1)

  • Much more common in persons of western European lineage who live in temperate zones

  • No population with a high risk for MS ...

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