MS diagnosis
|
Have you been diagnosed with MS |
Yes |
No |
If yes was it prior to APLS diagnosis |
SLE (Lupus) diagnosis
|
Have you been diagnosed with Lupus |
Yes
|
No |
If yes was it prior to APLS diagnosis |
Occular
|
Blurred or double vision |
Yes |
No |
If yes was it prior to diagnosis |
Visual disturbance ("wavy lines,"
"flashing lights") |
Yes |
No |
If yes was it prior to diagnosis |
Visual loss (field cuts, total vision
loss) |
Yes |
No |
If yes was it prior to diagnosis |
Retinal artery occlusion (only
if officially diagnosed) |
Yes |
No |
If yes was it prior to diagnosis |
Retinal vein thrombosis (only if
officially diagnosed) |
Yes |
No |
If yes was it prior to diagnosis |
Retinal artery occlusion
(only if officially diagnosed)
|
Yes
|
No
|
If yes was it prior to diagnosis |
Retinal vein
thrombosis (only if officially diagnosed)
|
Yes
|
No
|
If yes was it prior to diagnosis |
Cardiorespiratory
|
Chest pain
|
Yes
|
No
|
If yes was it prior to diagnosis |
Radiating arm pain
|
Yes
|
No
|
If yes was it prior to diagnosis |
Shortness of
breath
|
Yes
|
No
|
If yes was it prior to diagnosis |
Cardiac
|
Insufficiency murmur of
aortic, mitral valve (endocarditis) (only if officially diagnosed)
|
Yes
|
No
|
If yes was it prior to diagnosis |
Myocardial infarction
(Chest pain, diaphoresis
(sweating))
|
Yes
|
No
|
If yes was it prior to diagnosis |
Gastrointestinal
|
Abdominal pain
|
Yes
|
No
|
If yes was it prior to diagnosis |
Abdominal distension
(bloating)
|
Yes
|
No
|
If yes was it prior to diagnosis |
Abdominal migraine see
here for details
|
Yes
|
No
|
If yes was it prior to diagnosis |
Emesis (vomiting)
|
Yes
|
No
|
If yes was it prior to diagnosis |
Right upper quadrant
tenderness, hepatomegaly (Enlargement of the
liver) Budd-Chiari syndrome, hepatic small vessel thrombosis,
hepatic infarction)
|
Yes
|
No
|
If yes was it prior to diagnosis |
Abdominal tenderness
(mesenteric artery thrombosis)
|
Yes
|
No
|
If yes was it prior to diagnosis |
Pulmonary
|
Respiratory
distress
|
Yes
|
No
|
If yes was it prior to diagnosis |
Tachypnea (rapid breathing)
|
Yes
|
No
|
If yes was it prior to diagnosis |
Pulmonary embolism [PE]
|
Yes
|
No
|
If yes was it prior to diagnosis |
Pulmonary
hypertension
|
Yes
|
No
|
If yes was it prior to diagnosis |
Peripheral vascular
|
Leg pain
|
Yes
|
No
|
If yes was it prior to diagnosis |
Leg swelling
|
Yes
|
No
|
If yes was it prior to diagnosis |
Claudication (limping or
occasional limping)
|
Yes
|
No
|
If yes was it prior to diagnosis |
Digital
ulcerations (fingers, toes and can include hands and feet in this context due
to extended vein/arteries into surrounding area)
|
Yes
|
No
|
If yes was it prior to diagnosis |
Leg ulcerations
|
Yes
|
No
|
If yes was it prior to diagnosis |
Cold-induced finger and/or toe
pain
|
Yes
|
No
|
If yes was it prior to diagnosis |
Point tenderness to palpation
of bone or joints (bone infarction)
|
Yes
|
No
|
If yes was it prior to diagnosis |
Pain on range of motion of
joints without arthritis (avascular necrosis)
|
Yes
|
No
|
If yes was it prior to diagnosis |
Limb swelling
(Deep Vein Thrombosis - DVT)
|
Yes
|
No
|
If yes was it prior to diagnosis |
Peripheral edema (DVT, renal
vein thrombosis)
|
Yes
|
No
|
If yes was it prior to diagnosis |
Decreased capillary refill
(arterial thrombosis/vasospasm includes collapse of vein)
|
Yes
|
No
|
If yes was it prior to diagnosis |
Decreased pulses (arterial
thrombosis/Vasospasm)
|
Yes
|
No
|
If yes was it prior to diagnosis |
Decreased perfusion (arterial
thrombosis/vasospasm)
|
Yes
|
No
|
If yes was it prior to diagnosis |
Gangrene (arterial
thrombosis/infarction)
|
Yes
|
No
|
If yes was it prior to diagnosis |
Musculoskeletal
|
Bone pain
|
Yes
|
No
|
If yes was it prior to diagnosis |
Joint
pain
|
Yes
|
No
|
If yes was it prior to diagnosis |
Cutaneous
|
Purpuric and/or petechial
rashes
|
Yes
|
No
|
If yes was it prior to diagnosis |
Persistent or transient lacy
rashes of livedo reticularis
|
Yes
|
No
|
If yes was it prior to diagnosis |
Dusky fingers and/or
toes
|
Yes
|
No
|
If yes was it prior to diagnosis |
Blanching of fingers and/or
toes
|
Yes
|
No
|
If yes was it prior to diagnosis |
Purpuric lesions
|
Yes
|
No
|
If yes was it prior to diagnosis |
Superficial
thrombophlebitis
|
Yes
|
No
|
If yes was it prior to diagnosis |
Vasospasm (ie, Raynaud
phenomenon)
|
Yes
|
No
|
If yes was it prior to diagnosis |
Splinter hemorrhages
(periungual, subungual)
|
Yes
|
No
|
If yes was it prior to diagnosis |
Peripheral infarctions
(digital pitting)
|
Yes
|
No
|
If yes was it prior to diagnosis |
Skin ulcerations (eg, leg
ulcers)
|
Yes
|
No
|
If yes was it prior to diagnosis |
Bruising (associated with
thrombocytopenia)
|
Yes
|
No
|
If yes was it prior to diagnosis |
Neurologic and
psychiatric
|
Syncope
|
Yes
|
No
|
If yes was it prior to diagnosis |
Seizures
|
Yes
|
No
|
If yes was it prior to diagnosis |
Headache
(migraine)
|
Yes
|
No
|
If yes was it prior to diagnosis |
Ascending weakness
|
Yes
|
No
|
If yes was it prior to diagnosis |
Tremors
|
Yes
|
No
|
If yes was it prior to diagnosis |
Memory loss
|
Yes
|
No
|
If yes was it prior to diagnosis |
Problems with concentrating,
reading comprehension, calculations (change in performance)
|
Yes
|
No
|
If yes was it prior to diagnosis |
Stroke/CVA (cerebrovascular
accident)
|
Yes
|
No
|
If yes was it prior to diagnosis |
TIA
|
Yes
|
No
|
If yes was it prior to diagnosis |
Paresthesia, polyneuritis or
mononeuritis multiplex (vasovasorum(or blood vessel) ischemia/infarction)
|
Yes
|
No
|
If yes was it prior to diagnosis |
Paralysis, hyperreflexia,
weakness (transverse myelitis, Guillain-Barré syndrome)
|
Yes
|
No
|
If yes was it prior to diagnosis |
Abnormal movements/Movement disorders -
Choreiform tremors (cerebral, cerebellar, basal ganglia infarction)
|
Yes
|
No
|
If yes was it prior to diagnosis |
Multiple sclerosis–like
disorder (Not
sure what the medical profesion mean by this as it could
be all the other items on this list anyway. I suppose we
should all answer yes to this)
|
Yes
|
No
|
If yes was it prior to diagnosis |
Endocrine
|
Weakness
|
Yes
|
No
|
If yes was it prior to diagnosis |
Fatigue
|
Yes
|
No
|
If yes was it prior to diagnosis |
Arthralgia
|
Yes
|
No
|
If yes was it prior to diagnosis |
Abdominal pain (Addisonian features)
|
Yes
|
No
|
If yes was it prior to diagnosis |
Progressive stiffening of pelvic and thigh muscles with flexion contractures
associated with adrenal (kidney) insufficiency (adrenal
infarction/hemorrhage)
|
Yes
|
No
|
If yes was it prior to diagnosis |
Genitourinary
|
Hematuria (blood in urine)
|
Yes
|
No
|
If yes was it prior to diagnosis |
Peripheral
edema
|
Yes
|
No
|
If yes was it prior to diagnosis |
Renal (kidney)
|
Hypertension
|
Yes
|
No
|
If yes was it prior to diagnosis |
Renal artery
thrombosis
|
Yes
|
No
|
If yes was it prior to diagnosis |
Intrarenal vascular lesions
(scar tissue)
|
Yes
|
No
|
If yes was it prior to diagnosis |
Hematuria (blood in urine)
|
Yes
|
No
|
If yes was it prior to diagnosis |
Renal vein
thrombosis
|
Yes
|
No
|
If yes was it prior to diagnosis |
Pregnancy-related history
|
Miscarriage
|
|
If yes was it prior to diagnosis |
Premature birth |
Yes
|
No
|
If yes was it prior to diagnosis |
IUGR |
Yes
|
No
|
If yes was it prior to diagnosis |
Oligohydramnios |
Yes
|
No
|
If yes was it prior to diagnosis |
Chorea gravidarum |
Yes
|
No
|
If yes was it prior to diagnosis |
Placental infarction |
Yes
|
No
|
If yes was it prior to diagnosis |
Preeclampsia |
Yes
|
No
|
If yes was it prior to diagnosis |
Toxemia of pregnancy |
Yes
|
No
|
If yes was it prior to diagnosis |
Neonatal thromboembolism |
Yes
|
No
|
If yes was it prior to diagnosis |
Was Diagnosis made during tests
at pregnancy
|
Yes
|
No
|
|
Family history |
Family history of frequent miscarriage, premature
birth, IUGR, oligohydramnios, chorea gravidarum, placental infarction,
preeclampsia, toxemia of pregnancy, or neonatal thromboembolism |
Yes
|
No
|
Unknown
|
If yes was it prior to diagnosis |
Family history of MI or stroke in persons younger
than 50 years
|
Yes
|
No
|
Unknown
|
If yes was it prior to diagnosis |
Family history of DVT, phlebitis, or pulmonary
embolus
|
Yes
|
No
|
Unknown
|
If yes was it prior to diagnosis |
Strong family history of migraine, Raynaud
phenomenon, or TIAs
|
Yes
|
No
|
Unknown
|
If yes was it prior to diagnosis |
Medication history |
Use of oral contraceptives at the time of a clinical event. |
Yes
|
No
|
If yes was it prior to diagnosis |
Other long-term use of medication
|
|
Vaccinations received
|
|
Was there any traumatic stressful event that occured in the six months prior to
diagnosis |
|
Other Symptoms
|
|