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”). Isointense lesions are gray, the color of surrounding brain tissue.
MRI scans can be used to help detect MS and assess disease activity in all disease types. It also may help to identify early stages of MS-like disease. MS lesions are generally visible on MRI scans from the earliest stages of the disease, and they may even be apparent before a person experiences any MS 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.
Multiple sclerosis lesions can occur anywhere in the CNS, and thus MRI of the cervical, thoracic and lumbar spine should be considered in patients with symptoms referable to these locations, and for detecting subclinical lesions (particularly in the spinal cord).
MS is best detected by a neurological examination and painless imaging studies of the brain and spinal cord using magnetic resonance testing (MRI). An ophthalmologist also can use a test called an optical coherence tomography (OCT) to determine if the optic nerve has been affected by MS.
Those symptoms include loss of vision in an eye, loss of power in an arm or leg or a rising sense of numbness in the legs. Other common symptoms associated with MS include spasms, fatigue, depression, incontinence issues, sexual dysfunction, and walking difficulties.
People should consider the diagnosis of MS if they have one or more of these symptoms: vision loss in one or both eyes. acute paralysis in the legs or along one side of the body. acute numbness and tingling in a limb.
Although MRI is a very useful diagnostic tool, a normal MRI of the brain does not rule out the possibility of MS. About 5 percent of people who are confirmed to have MS do not initially have brain lesions evidenced by MRI.
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. Resolution is often complete.
Some of the most common mimics include migraine and chronic cerebrovascular disease, according to Dr Schiess. Vasculitic autoimmune diseases such as systemic lupus erythematosus (SLE) and Sjögren's syndrome can also result in white matter abnormalities on MRI.
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.
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.
MS brain lesions may appear on the brainstem—the lowest part of the brain right above the spinal cord. Among the symptoms that can appear with MS brainstem lesions are blurred or double vision, trouble swallowing, slurred speech, dizziness, coordination problems, weakness, and decreased sensation.
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”). Isointense lesions are gray, the color of surrounding brain tissue.
There are also multiple infectious entities that mimic MS including; progressive multi-focal leukoencephalopathy (PML), Toxoplasmosis, Tuberculosis, Herpes Simplex Virus, Cytomegalovirus, Varicella zoster virus, Epstein Barr virus, Cryptococcus and Human immunodeficiency virus.
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.
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.
While there is no definitive blood test for MS, blood tests can rule out other conditions that cause symptoms similar to those of MS, including lupus erythematosis, Sjogren's, vitamin and mineral deficiencies, some infections, and rare hereditary diseases.
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.
Unfortunately, anxiety causes many of the same symptoms as the early stages of MS. MS is one of the health issues that comes up most when those with anxiety search for their symptoms online, and millions of those with anxiety convince themselves that they might have MS.
MRI has greater than 90% sensitivity in the diagnosis of MS; however, other white matter diseases can sometimes have a similar appearance on medical imaging.
Neurological examination
Your neurologist will look for abnormalities, changes or weakness in your vision, eye movements, hand or leg strength, balance and co-ordination, speech and reflexes. These may show whether your nerves are damaged in a way that might suggest MS.
We know early treatment improves long-term health and wellbeing by slowing down the build up of irreversible damage and reducing the number of relapses people experience. Starting MS treatment early is best but if you start later it can also have some benefits.