Liquordiagnostik der Multiplen Sklerose – Diagnose und Differenzialdiagnose

Bei der Multiplen Sklerose handelt es sich um eine chronisch–entzündliche Erkrankung des zentralen Nervensystems mit funktionellen Defiziten vorwiegend aufgrund multipler demyelinisierender Läsionen unterschiedlichen Alters. Grundkonzept der Diagnosestellung ist der Nachweis einer Dissemination des Krankheitsprozesses in Bezug auf Ort und Zeit. Die diagnostischen Kriterien der Multiplen Sklerose wurden wiederholt revidiert. Der Artikel gibt einen Überblick über verschiedene Kriteriensysteme und diskutiert die derzeit verwendeten McDonald–Kriterien in ihrer revidierten Fassung von 2005. Die Diagnosestellung der Multiplen Sklerose beruht auf dem Ausschluss anderer entzündlicher, infektiöser, granulomatöser und hereditärer Erkrankungen, die nachfolgend skizziert werden. Ein klinischer Abklärungsalgorithmus bei Verdacht auf Multiple Sklerose wird vorgestellt. Im Rahmen der Diagnosestellung ist die Liquoranalyse essenziell, charakteristische Liquorbefunde und ihre Bedeutung werden diskutiert.

Multiple Sclerosis (MS) is defined as a chronic inflammatory disease of the central nervous system with functional deficits predominantly due to multiple demyelinated and axonal lesions of different age. The basic concept of diagnosis relies on confirming dissemination of the disease process in time and space. The diagnostic criteria of MS were revised several times, the article gives an overview over different sets of diagnostic criteria and discusses the most recent version of the McDonald criteria, 2005. Several inflammatory, infectious, granulomatous and hereditary diseases may resemble MS and have to be excluded in the diagnostic process. An algorithmic approach to patients with suspected MS is described. In diagnosing MS analysis of the cerebrospinal fluid (CSF) plays an essential role, characteristic findings in CSF and their significance are discussed.

Key words

Multiple sclerosis - diagnostic criteria - cerebrospinal fluid analysis

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