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.
An MRI scan can differentiate between active and non-active lesions. Active lesions show up in the scan as white patches when a contrast fluid containing gadolinium is injected. If the lesion does not light up, then it is likely to be an older lesion, and more than 3 months old.
MS-related lesions appear on MRI images as either bright or dark spots, depending on the type of MRI scan. This imaging technique is useful because it shows active inflammation and helps doctors determine the age of the lesions. Also, some specific types of lesions can indicate a flare-up of MS or damage in the brain.
The course of enhancement is transient and usually is shorter than 6 months; rarely it may persist for a longer time. The appreciation of the evolution of MS-enhanced lesions aids in both identifying new MS lesions and distinguishing these lesions from other pathologic entities.
Diagnosing MS
More than 90% of people with MS have scar tissue that shows up on an MRI scan. A spinal tap can check for abnormalities in the fluid that bathes the brain and spinal cord. Tests to look at electrical activity of nerves can also help with diagnosis.
Thus, MS lesions themselves cannot be felt. Instead, they may induce symptoms that result from tissue damage to the nervous system. The symptoms and signs of MS can vary depending on the particular location of the lesion.
Multiple sclerosis lesions can occur in any portion of the cerebellar white matter and peduncles, frequently involving the middle and superior cerebellar peduncles (Fig. 3). However, prominent involvement of this region is also seen in anti-MOG-IgG disease and progressive multifocal leukoencephalopathy.
An “average” number of lesions on the initial brain MRI is between 10 and 15. However, even a few lesions are considered significant because even this small number of spots allows us to predict a diagnosis of MS and start treatment.
New lesions might occur in patients with progressive MS and adjusting therapy can be considered. Patients with untreated CIS should be scanned every 1–3 months for the initial 6 months and if stable repeating MRIs every 6–12 months is recommended, unless new clinical symptoms occur.
Signs and Symptoms
Characteristic lesions are located in the periventricular and juxtacortical regions, in addition to the brainstem, cerebellum, spinal cord, and optic nerve.
Hyperintense lesions are bright or white. In general, MS lesions are hyperintense or bright on T2 or FLAIR sequences. Hypointense lesions are dark or black. In general, old MS lesions are hypointense or dark on T1 sequences (“black holes”).
The Criteria for a Diagnosis of MS
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 least one month apart; AND. Rule out all other possible diagnoses.
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.
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.
Changes in the size, shape, or color of a mole or growth. A lesion that is rough, oozing, bleeding, or scaly. A sore lesion that will not heal. Pain, itching, or tenderness to a lesion.
As mentioned earlier, altered sensations like numbness and tingling are often an early sign of MS. However, these sensations can come or go at any point. It's possible that numbness and tingling can happen during an MS relapse.
The cervical region is the upper part of the spine found in the neck. MS lesions on the cervical spine can cause similar symptoms to when they appear in other areas, such as numbness, weakness, and balance issues. In addition, they can cause loss of sensation in both the shoulders and arms.
Relapsing MS and the McDonald criteria
A person who has experienced at least two clinical attacks, and has clear-cut evidence of damage in at least two distinct brain areas, can be definitively diagnosed with MS, as that individual fulfills requirements for both dissemination in space and time.
Over 25,600 people in Australia are living with multiple sclerosis, including 3,700 Queenslanders, and it affects each person differently. On average more than 10 Australians are diagnosed with MS every week.
Numbness of the face, body, or extremities (arms and legs) is often the first symptom experienced by those eventually diagnosed as having MS.
There is another way in which MS can affect behaviour and mood. MS causes changes in parts of the brain and spinal cord. Lesions (MS plaques and other brain changes) in the brain sometimes result in behavioural changes.
Multiple sclerosis (MS) is a disease of the central nervous system that causes damage to your brain, spinal cord, and optic nerves. It's characterized by lesions, or areas of tissue damage that occur when your immune system behaves abnormally and attacks these areas.
Typical multiple sclerosis lesions are round to ovoid in shape and range from a few millimetres to more than one or two centimetres in diameter.
But the brain isn't the only area where lesions can develop — MS can also attack the spinal cord. Because finding these lesions involves more elaborate imaging tests, spinal cord lesions in MS are studied less often, and many people with MS aren't aware of the role these lesions may play in the disease process.