NGHIÊN CỨU ĐẶC ĐIỂM LÂM SÀNG VÀ CẬN LÂM SÀNG TRONG BỆNH XƠ CỨNG RẢI RÁC CÓ BIỂU HIỆN MẮT

Abstract

Purpose: To analyze relevant clinical and laboratory features in the diagnosis of multiple sclerosis with ocular manifestations. Methods: A retrospective descriptive and analytical study included 36 patients with multiple sclerosis confirmed diagnosis according to the 2010 McDonald criteria and 36 patients with a diagnosis of optic neuritis due to other causes having complete medical history, clinical symptoms, magnetic resonance imaging, laboratory tests, cerebrospinal fluid tests, clinical symptoms after 5 days of acute exacerbation treatment with Solumedrol 1000mg/day. Results: Average age of onset 31.75 ± 12.2, ≤ 40 years old accounts for 75%. Younger people (≤ 40 years old) are more likely to have visual onset symptoms, while older people (> 40 years old) ưere more likely to have motor and sensory symptoms. The average number of relapses was 3.8 with 50% of eyes having finger-count vision < 3m after 5 relapses, 50% of patients lost their working capacity after 4 relapses. The rate of lesion locations on MRI appearing in time and space to help diagnose multiple sclerosis is in the order of brain 86.1%, optic nerve 80.6% and spinal cord 72.2%. The relapsing type was the most common compared with the other types (88.9%). Before a patient with optic neuritis has all three features including optic nerve hyperintensity on T2-weighted images, female gender and age ≤ 40 years, the likelihood of multiple sclerosis was 15 times higher than in patients without these factors (OR = 15; 95% CI 2.5-92.1; p = 0.004). Conclusion: Patients with optic neuritis who present with optic nerve hyperintensity nerve on MRI, age ≤ 40 years and women should have a mandatory cranial MRI 3 months later to confirm the diagnosis. Early treatment of multiple sclerosis with immunosuppressive drugs to prevent complications of blindness and early loss of work capacity in young people.