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).
The misdiagnosis of multiple sclerosis (MS) is a problem with significant consequences for patients as well as the healthcare system. 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.
Sjogren's syndrome is an autoimmune disease that can mimic some of the symptoms of MS such as fatigue and joint pain.
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 ...
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.
MRI plays a vital role in how we diagnose and monitor MS. In fact, over 90% of people have their MS diagnosis confirmed by MRI.
MS is an autoimmune condition. This is when something goes wrong with the immune system and it mistakenly attacks a healthy part of the body – in this case, the brain or spinal cord of the nervous system. In MS, the immune system attacks the layer that surrounds and protects the nerves called the myelin sheath.
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.
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.
Magnetic resonance imaging (MRI)
It's very accurate and can pinpoint the exact location and size of any inflammation, damage or scarring (lesions). MRI scans confirm a diagnosis in over 90 per cent of people with MS.
Undetected and untreated vitamin B12 deficiency can lead to anemia and permanent nerve and brain damage. Cobalamin deficiency often manifests with neurologic symptoms and may rarely mimic multiple sclerosis (MS) among other neurological disorders.
Numbness of the face, body, or extremities (arms and legs) is often the first symptom experienced by those eventually diagnosed as having MS.
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.
Vision problems are an early sign of MS. Gait and mobility changes: MS can change the way people walk due to muscle weakness and problems with balance, dizziness, and fatigue. Emotional changes and depression: Demyelination and nerve fiber damage in the brain can trigger emotional changes.
Women are up to three times as likely as men to have relapsing-remitting MS. The risk for MS in the general population is about 0.5%. If a parent or sibling has MS, your risk is about twice that or about 1%. Certain infections are also important.
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.
Current evidence shows that simply having MS does not make you more likely than the general population to develop COVID-19, become severely ill or die from the infection. However, certain factors have been shown to increase the risk of a severe case of COVID-19: Progressive MS. Older age.
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.
Diagnosis and early intervention
As optic neuritis is the presenting sign of MS in up to 30 percent of patients, the eye exam can lead to the initial systemic diagnosis.
Here's where MS (typically) starts
Although a number of MS symptoms can appear early on, two stand out as occurring more often than others: Optic neuritis, or inflammation of the optic nerve, is usually the most common, Shoemaker says. You may experience eye pain, blurred vision and headache.
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).
People may experience blurred vision, double vision, eye pain or loss of color vision. Difficulty articulating words or swallowing and slurred speech may occur if there's damage to the area that controls the mouth and throat.