Multiple sclerosis (MS) is characterized by inflammatory white matter damage within the central nervous system (e.g. demyelination, astrocytic hypertrophy).
White matter lesions (WML) are a frequent neuroradiological finding in brain MRI with a large number of underlying causes [1]. Two of the most common etiologies are multiple sclerosis (MS) and vascular disorders causing small vessel disease (SVD), each with distinct and characteristic features [2, 3].
White matter T2 hyperintensities in the brain are not specific to MS and are seen in a number of other disorders. They can even be seen in otherwise normal individuals, particularly with increasing age.
MS has long been considered an auto-immune disease primarily affecting the white matter (WM).
Dr. Carlson notes that about 2% to 4% of patients misdiagnosed with MS are eventually diagnosed with genetic white matter disease, or genetic leukodsytrophies.
Migraines are one of the most common mimicker diseases that can be misdiagnosed for MS. Migraine causes intense throbbing headaches, light sensitivity, and nausea. Many migraine sufferers have also experienced blurred vision similar to the kind caused by optic neuritis in MS patients.
Some conditions that doctors may commonly misdiagnose as MS include migraine, RIS, spondylopathy, and neuropathy. To accurately diagnose MS, doctors must rule out conditions with similar symptoms and look for signs and symptoms specific to MS. As such, the process of diagnosing MS may be lengthy and complex.
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.
However, using tissue staining techniques, the Cleveland Clinic researchers observed that 12 of 100 postmortem brains obtained from patients with MS in their study did not exhibit cerebral white matter lesions indicative of demyelination.
It can affect any arteries in your body, including ones in your brain. Having cardiovascular risk factors, such as high blood pressure, elevated blood sugar (from diabetes), high dietary fat intake (high cholesterol) and smoking can all increase the number of white matter spots or lesions in your brain.
An MRI scan can detect MS activity early on , sometimes before an individual experiences any worsening symptoms.
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.
Diagnosing MS
More than 90% of people with MS have scar tissue that shows up on an MRI scan. A spinal tap can check for abnormalities in the fluid that bathes the brain and spinal cord. Tests to look at electrical activity of nerves can also help with diagnosis.
Studies have found that white matter lesions appear in some degree on brain scans of most older adults but less often in younger people. White matter lesions are among the most common incidental findings—which means the lesions have no clinical significance—on brain scans of people of any age.
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.
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.
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.
Signs and Symptoms
Characteristic lesions are located in the periventricular and juxtacortical regions, in addition to the brainstem, cerebellum, spinal cord, and optic nerve.
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.
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.
There is a new blood test that may monitor multiple sclerosis disease activity better in clinically stable patients. The test is called sNfL (serum neurofilament). It measures the breakdown of a certain part of neurons, which occurs when multiple sclerosis is attacking the nervous system.
It is also known as neuromyelitis optica (NMO) or Devic's disease. Some of its symptoms are similar to the symptoms of multiple sclerosis, so it may be misdiagnosed as such.
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.
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.