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.
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.
While it is true that almost all people with MS will have evidence of brain lesions on MRI, not all people with brain lesions have MS.
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.
The tests could still be inconclusive
Not necessarily. If you have MS, you still might not have tested positive in all the MS tests.
MRI: MRI is the best imaging technology to detect scarring or MS plaques in different parts of the central nervous system (CNS). This test can also distinguish old MS plaques from those that are currently active or new.
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.
Signs and Symptoms
Characteristic lesions are located in the periventricular and juxtacortical regions, in addition to the brainstem, cerebellum, spinal cord, and optic nerve.
Answer: You can certainly have a normal neurological exam and still have multiple sclerosis.
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.
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.
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.
An MRI scanner uses a strong magnetic field to create a detailed image of inside your brain and spinal cord. 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 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.
Sjogren's syndrome is an autoimmune disease that can mimic some of the symptoms of MS such as fatigue and joint pain.
Does early MS show up on an MRI? 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.
There are rare cases where someone can have MS but their MRI will look clear. This happens. That doesn't mean they can't get a diagnosis of multiple sclerosis, but it does make it significantly more difficult.
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. Visual loss rarely progresses beyond 2 weeks from the onset. Visual recovery usually takes longer than 2 weeks and may not recover to baseline.
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.
MS lesions developed preferentially in the supratentorial brain, particularly the frontal lobe and the sublobar region.
The hallmark of MS pathology is the focal demyelinated lesion, or “plaque,” present in the white matter of the optic nerves, brain, and spinal cord.
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.
The symptoms can be similar, but people with fibromyalgia are more likely to experience depression, irritable bowel syndrome, and widespread, persistent pain. Symptoms more common with MS include weakness, vision problems, muscle spasms, and bowel or bladder issues.
But despite some similarities, “for the most part, there is no mistaking symptoms of MS with fibromyalgia,” says Philip Cohen, MD, a rheumatologist, professor of medicine and professor of microbiology and immunology at the Lewis Katz School of Medicine at Temple University in Philadelphia.
Nail problems are common, and they are not usually serious. If a person has multiple sclerosis (MS), nail problems can cause pain or discomfort. While nail issues are not directly related to the disease, determining the cause may help prevent a person with MS from experiencing further discomfort.