How is MS diagnosed? In MS, the immune system mistakenly attacks tissue in the brain, spinal cord and optic nerve, collectively known as the central nervous system (CNS). This occurs in localised areas in the CNS known as lesions, and can be seen in a brain scan (Magnetic Resonance Imaging or MRI).
Sometimes an MRI reviewed by a radiologist can provide enough evidence to make a diagnosis. But in the case of MS, it takes a combination of the MRI with the patient's clinical symptoms, history, and neurological examination to make the diagnosis.
What is unique about imaging for MS? While general brain scans are often performed using computerized tomography (CT), MRIs are used to scan for MS; in the images, doctors are looking for abnormal white matter. “The benefit of MRI is that it shows a very good depiction of brain tissue compared to CT,” Dr.
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.
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.
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.
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.
In primary progressive MS, symptoms would be expected to have a gradual and insidious onset over at least 12 months by the time of diagnosis. A common first presentation of RRMS is with unilateral optic neuritis characterised by gradual onset monocular visual loss, pain on moving the eye and altered colour vision.
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.
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.
Signs and Symptoms
Characteristic lesions are located in the periventricular and juxtacortical regions, in addition to the brainstem, cerebellum, spinal cord, and optic nerve.
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.
MS can be present even with a normal MRI and spinal fluid test although it's uncommon to have a completely normal MRI. Sometimes the MRI of the brain may be normal, but the MRI of the spinal cord may be abnormal and consistent with MS, so this also needs to be considered.
In most people with relapsing-remitting MS , the diagnosis is straightforward and based on a pattern of symptoms consistent with the disease and confirmed by brain imaging scans, such as an MRI. Diagnosing MS can be more difficult in people with unusual symptoms or progressive disease.
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.
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.
Answer: You can certainly have a normal neurological exam and still have multiple sclerosis.
White spots on a brain MRI are not always a reason to worry. There are many possible causes, including vitamin deficiencies, infections, migraines, and strokes. Other risk factors for white spots include getting older, race/ethnicity, genetics, obesity, diabetes, hypertension, and high cholesterol.
They will examine you to check how different parts of your nervous system are working. A combination of tests is used to diagnose MS. The best test is an MRI of your brain and spinal cord to detect areas of damage. You might also need to have blood tests, a lumbar puncture and tests to measure nerve activity.
Relapsing-Remitting MS (RRMS)
The most common type of MS is called RRMS. It is defined by temporary periods called relapses, flare-ups or exacerbations, when new symptoms appear. Individuals with this MS type experience clearly defined attacks of worsening neurologic condition.
MS brain lesions can cause coordination problems, dizziness, slurred speech, muscular weakness, and sensation loss. The location of these lesions dictates which symptoms a person experiences. There is no cure for MS, but several treatment modes can help people to manage the condition.
MS lesions developed preferentially in the supratentorial brain, particularly the frontal lobe and the sublobar region.