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Resumen La esclerosis multiple (EM) es la patologia inflamatoria autoimnune mas frecuente del sistema nervioso central, caracterizandose patologicamente por areas multifocales de desmielinizacion con perdida de oligodendrocitos, gliosis cicatricial y dano axonal en estadios mas evolucionados, siendo una causa muy frecuente de discapacidad en gente joven. Aunque existen formas de presentacion atipicas, el diagnostico clinico es relativamente sencillo en pacientes jovenes con sintomatologia de inicio tipica como la neuritis optica, el sindrome troncoencefalico y las mielitis transversas incompletas, y con presencia de lesiones desmielinizantes en la resonancia magnetica que cumplan los criterios de diseminacion en tiempo y espacio, pudiendose realizar el diagnostico de EM en un primer brote clinico segun los criterios revisados de McDonald 2017, en ausencia de otra etiologia mas plausible. El estudio del liquido cefalorraquideo nos ayuda a determinar el caracter inflamatorio de esta enfermedad al demostrar sintesis intratecal y presencia de bandas oligoclonales de IgG, considerandose criterio diagnostico en las formas de EM primarias progresivas y criterio de diseminacion en tiempo en un primer brote clinico. 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. |
