MRIs are not a 100 percent positive in the diagnosis of MS. In 5 percent of the people showing clinical MS disease activity, lesions were not visible on the MRI. However, if follow-up MRI studies continue to show no lesions, the MS diagnosis should be reconsidered.
MRI scans are an important way to help health care providers figure out if a person has MS or not, but MRI scans cannot diagnose MS by themselves. While it is true that almost all people with MS will have lesions on MRI, not all people with MRI lesions have MS.
Nearly one in five patients with an established diagnosis of multiple sclerosis (MS) are misdiagnosed, according to a 2019 study led by Cedars-Sinai. "Many physicians think diagnosing MS is simple," Marwa Kaisey, MD, one of the study's lead authors, said.
MRI is considered the best test to help diagnose MS. However, 5% of people with MS do not have abnormalities detected on MRI; thus, a "negative" scan does not completely rule out MS. In addition, some common changes of aging may look like MS on a MRI.
If you have MS and it's early in the disease course, you might not have tested positive in all the MS tests. In fact, you might not have tested positive in any of the tests.
About 5 percent of people who are confirmed to have MS do not initially have brain lesions evidenced by MRI. However, the longer a person goes without brain or spinal cord lesions on MRI, the more important it becomes to look for other possible diagnoses.
A wide range of conditions can be mistaken for MS, including: migraine, cerebral small vessel disease, fibromyalgia, functional neurological disorders, and neuromyelitis optica spectrum disorders, along with uncommon inflammatory, infectious and metabolic conditions (1, 3).
Devic's disease, also known as neuromyelitis optica (NMO) spectrum disorder, is a rare neuro-immune disorder that affects your eyes and your spinal cord. It may also attack the brain. Neuroimmune means that the immune system mistakenly attacks the nervous system as if it were a threat.
There are no specific tests for MS . Instead, a diagnosis of multiple sclerosis often relies on ruling out other conditions that might produce similar signs and symptoms, known as a differential diagnosis. Your doctor is likely to start with a thorough medical history and examination.
Tests for multiple sclerosis. Diagnosing MS is complicated because no single test can positively diagnose it. Other possible causes of your symptoms may need to be ruled out first. It may also not be possible to confirm a diagnosis if you have had only 1 attack of MS-like symptoms.
Signs and Symptoms
Characteristic lesions are located in the periventricular and juxtacortical regions, in addition to the brainstem, cerebellum, spinal cord, and optic nerve.
There are nearly 1 million people in the United States living with the disease. And researchers now say nearly 20 percent of them are misdiagnosed.
In order to make a diagnosis of MS, the physician must: Find evidence of damage in at least two separate areas of the central nervous system (CNS), which includes the brain, spinal cord and optic nerves AND. Find evidence that the damage occurred at different points in time AND. Rule out all other possible diagnoses.
Lesions may be observed anywhere in the CNS white matter, including the supratentorium, infratentorium, and spinal cord; however, more typical locations for MS lesions include the periventricular white matter, brainstem, cerebellum, and spinal cord.
Most symptoms develop abruptly, within hours or days. These attacks or relapses of MS typically reach their peak within a few days at most and then resolve slowly over the next several days or weeks so that a typical relapse will be symptomatic for about eight weeks from onset to recovery.
If you've gone some time without relapses, or your MRI scans show no new or growing lesions, then your neurologist might describe your MS as 'not active'. That doesn't mean you have no symptoms – you might still have some left over from earlier attacks on your nerves. And it doesn't mean your MS has gone for good.
These include fibromyalgia and vitamin B12 deficiency, muscular dystrophy (MD), amyotrophic lateral sclerosis (ALS or Lou Gehrig's disease), migraine, hypo-thyroidism, hypertension, Beçhets, Arnold-Chiari deformity, and mitochondrial disorders, although your neurologist can usually rule them out quite easily.
Sjogren's syndrome is an autoimmune disease that can mimic some of the symptoms of MS such as fatigue and joint pain.
There are three main investigations that, because of their high specificity and sensitivity, are valuable in the diagnosis of MS: magnetic resonance imaging (MRI), evoked potentials; and cerebrospinal fluid (CSF) examination for the presence of oligoclonal bands (OCBs).
Neuromyelitis optica is often misdiagnosed as multiple sclerosis (MS) or seen as a type of MS . But NMO is a different condition. Neuromyelitis optica can cause blindness in one or both eyes, weakness or paralysis in the legs or arms, and painful spasms.
The case for Epstein-Barr virus (EBV)
The studies found that: Antibodies (immune proteins that indicate a person has been exposed) to EBV were significantly higher in people who eventually developed MS than in control samples of people who did not get the disease.
Dysesthesia is an unpleasant “altered” sensation like burning, prickly pins-and-needles, numbness, and creepy-crawlies in any part of your body. For example, your feet might suddenly feel scalded, with no heat source -- or damage -- at all.
Hypoxic-ischemic vasculopathy, specially small-vessel disease, inflammatory disorders, vasculitis, and non-MS idiopathic inflammatory disorders, as well as some toxic, metabolic, and infectious disorders, may present mimicking MS on MR examinations and should be included in the differential diagnosis of MS-like lesions ...
What do MS lesions feel like? Even though the central nervous system is packed with nerve cells, the brain tissue itself does not have so-called noniceptors — the sensory nerve fibers that detect pain and potentially damaging stimuli. Thus, MS lesions themselves cannot be felt.
To make a proper MS diagnosis, physicians must: Find evidence of damage in at least two separate areas of the central nervous system (CNS) – including the brain, spinal cord and optic nerves. Find evidence of damage occurring at least one month apart. Rule out all other possible diagnoses.