MS can cause a wide variety of neurologic symptoms since it can affect numerous areas of the brain, optic nerve, and spinal cord (Figure 3). Characteristic lesions are located in the periventricular and juxtacortical regions, in addition to the brainstem, cerebellum, spinal cord, and optic nerve.
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.
Classically, the MRI shows lesions in the white matter deep in the brain near the fluid spaces of the brain (the ventricles). The test may also show changes in the cortex or near the cortex. MRI can also show changes in the brainstem and in the spinal cord.
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.
When a damaged nerve “short circuits,” it can cause a sharp pain or a burning or squeezing sensation. A common pain in MS is what's known as Lhermitte's sign. “This occurs when there's a lesion on the cervical spine, the neck area of the spinal cord,” says Dr. Scherz.
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.
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.
Usually, MS lesions are detected via imaging using MRI scans. It is possible for a person to have MS lesions that aren't visible on these scans — for example, some lesions may be too small to be seen.
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.
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.
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.
MS activity appears on an MRI scan as either bright or dark spots. Typical MS lesions tend to be oval or frame shaped. MS lesions can appear in both the brain's white and gray matter. Healthcare professionals may use a chemical contrast dye called gadolinium to improve the brightness of MRI scan images.
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.
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.
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.
Multiple Sclerosis: It's in Your Head
While many symptoms of MS throughout the body can be caused by lesions in either the brain or the spinal cord, cognitive symptoms of MS — those related to your memory, language, and problem solving — are believed to be caused only by lesions in the brain.
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.
About 15% of patients will never necessitate assistance with ambulation, while 5-10% will do so within 5 years, and another 10% will do so in 15 years. Average patient will take about 28 years from the point of diagnosis to necessitate assistance while walking, and will be about 60 years of age.
MS is usually diagnosed between the ages of 20 and 50, but it can go undetected for years. In fact, a 2021 study suggested that many people with MS experience disease symptoms several years before being officially diagnosed with the disease.
For the diagnosis of multiple sclerosis, there should be at least one typical multiple sclerosis lesion in at least two characteristic regions [periventricular (abutting the lateral ventricles), juxtacortical/cortical, infratentorial, spinal cord] to support dissemination in space (Thompson et al., 2018).
The diagnosis of multiple sclerosis cannot be specifically made with one lesion. However, there certainly can be a very high suspicion of multiple sclerosis.
Bakshi concluded: "Patients who have a more severe form of MS have a median number of three [hyperintense T1 lesions]; the relapsing-remitting patients have only one." Dr.
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.