A diagnosis of multiple sclerosis ms requires not only the demonstration of cns lesions disseminated in time and space but also the active exclusion of alternative diagnoses. Multiple sclerosis diagnosis and treatment mayo clinic. For a course for continuing education interest in topic surfing the web. Miller1,5 fmedsci 1 queen square multiple sclerosis centre, ucl institute of neurology, london, united kingdom. Neurologic differential diagnosis pdf free download. Differential diagnosis of scleroderma and pseudoscleroderma. Background and objectives diagnosis of multiple sclerosis ms requires exclusion of diseases that could better explain the clinical and paraclinical findings. The diagnosis of multiple sclerosis and its many differential diagnoses can still be challenging but progress continues to be made. Pdf diagnosis and differential diagnosis of multiple. Multiple sclerosis ms is the most common permanently disabling disorder of the central nervous system in young adults.
Pdf differential diagnosis, clinical features, and. This pretty much includes any pathological process that can reflect injury to the central. How useful is the online multiple sclerosis tutorial. The differential diagnosis of multiple sclerosis journal. 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. Classification, diagnosis, and differential diagnosis of. Initial evaluations for multiple sclerosis in a university multiple sclerosis center. It is also the most common cause of neurological disability in young adults. The majority of patients with ms will have muscle weakness in their extremities as well as paresthesias. Differential diagnosis of multiple sclerosis request pdf. Current 2017 mcdonald diagnostic criteria for multiple sclerosis include clinical, imaging and laboratory findings thompson et al. Differential diagnosis of multiple sclerosis due wednesday, 3399 1. Differential diagnoses multiple sclerosis case study.
An international panel of ms experts developed consensus perspectives on ms differential diagnosis. Importantly, adem is a diagnosis of exclusion necessitating a search for alternative etiologies. Overview and differential diagnosis of papilledema uptodate. Apr 25, 2020 what are the differential diagnoses for multiple sclerosis. It may be elevated in either serum or csf but is not reliably abnormal. In general, atypical features of pediatric multiple sclerosis ms include fever, encephalopathy, progressive symptoms or disease course, other organ system involvement including the peripheral nervous system, absence of csf ocbs, elevated igg index, and markedly elevated csf leukocytes. The article mainly tackles the problem of different diagnosis criteria between acute disseminated encephalomyelitis adem and multiple sclerosis ms during the acute phase of the first episode in a population aged 15. Mri of the brain may reveal atrophy, cortical and deep gray matter lesions related to ischemia fig. Fabry disease underestimated in the differential diagnosis. A systematic process for exclusion of alternative diagnoses has not been defined. What are the differential diagnoses for multiple sclerosis.
The differential diagnosis of adem is wide and includes such entities as infectious meningoencephalitis, multiple sclerosis, nmo spectrum disorder, leukodystrophies, cns vasculitis, cns malignancies, and neurosarcoidosis, among others. Diagnosis, differential diagnosis, and misdiagnosis of. The views and discussions in the book are fresh and uptodate. Abstract the increasing availability of effective therapies for multiple sclerosis as well as research demonstrating the benefits of early treatment highlights the importance of expedient and accurate multiple sclerosis diagnosis. Angiotensinconverting enzyme determination may be used for further differential diagnosis. May 28, 2019 a diagnosis of multiple sclerosis ms requires not only the demonstration of cns lesions disseminated in time and space but also the active exclusion of alternative diagnoses. Diagnosis and management of multiple sclerosis american. Patient family friend of patient physician nurse medical student nursing student undergraduate k12 faculty other please specify. Case report multiple sclerosis as differential diagnosis of radionecrosis for postirradiation brain lesions. Occasionally, however, a rogue erythrocyte sedimentation rate esr, an atypical or normal mri scan, or an unexpected symptom. Pdf diagnosis and differential diagnosis of multiple sclerosis.
Differential diagnosis of multiple sclerosisfebruary 22, 1999 1 homework 5. Evoked potential studies in the antiphospholipid syndrome. Differential diagnosis of suspected multiple sclerosis. Recent research developments have helped improve the accuracy of multiple sclerosis diagnosis, especially with regard to. Multiple sclerosis knowledge for medical students and.
Magnetic resonance imaging in multiple sclerosis magnims network and the consortium of multiple sclerosis centers have given recommendations on the use of mri in ms diagnosis. Differential diagnosis is complicated by the fact that several pseudosclerodermas can imitate scleroderma beyond the symptom of sclerosis of the skin, and that, in rare cases, visceral scleroderma can occur without sclerosis of the skin 4. Differential diagnosis of multiple sclerosis sciencedirect. Therefore, when damage in the cns is big enough to be seen. Relapsing remitting ms is the most common type, and typical symptoms. Differential diagnosis of multiple sclerosis neurology. The most important tools are the medical history, a careful and thorough neurologic exam, and magnetic resonance imaging mri.
Scientific advances in the past 7 years suggest that they might no longer provide the most uptodate guidance for clinicians and researchers. Due to its clinical symptoms and frequent mri lesions, fabry disease is commonly misdiagnosed as multiple sclerosis. Differential diagnosis of multiple sclerosis 2092 words. Diagnosis of multiple sclerosis ms requires exclusion of diseases that could better explain the clinical and paraclinical findings. Multiple sclerosis ms is an acquired idiopathic, inflammatory demyelinating disorder of the central nervous system cns in which the myelin sheath is disrupted due to genetic and environmental factors 1, 2. Classification, diagnosis, and differential diagnosis of mul. This question is for testing whether or not you are a human visitor and to prevent automated spam submissions. Pdf the differential diagnosis of multiple sclerosis. Ms has a higher prevalence among women and people in temperate regions such as europe and north america. The diagnosis of ms is a clinical diagnosis, meaning that the. The basic pathological data for ms have been unveiled by the histopathological studies started by carswell in 1838, and cruveilhier. Multiple sclerosis ms is the most common acquired demyelinating disorder of the central nervous system cns.
Pdf the diagnosis of multiple sclerosis ms relies on the occurrence of characteristic symptoms, on the patients history and on the correct. Guidelines for differential diagnosis of suspected. Myelin damage and the nervous system mayo clinic, 2017 rationale. Multiple sclerosis ms is the most common demyelinating disease of the central nervous system cns and it has a genetic susceptibility noseworthy et al. A clinical approach to the differential diagnosis of multiple sclerosis. Fabry disease is a rare xlinked inherited lysosomal storage disorder affecting multiple organ systems. Central nervous system involvement and the course of the disease may show striking similarity to ms. This article discusses approaches to the clinical assessment for ms that may improve diagnostic accuracy. The patients complaints of progressive numbness over that past year with the occurrence of a fall while running combined with her age and gender indicates the possibility of this diagnosis. When a patient has a first attack of demyelination, the physician should not rush to diagnose ms, because the differential diagnosis includes a number of other diseases.
Differential diagnosis of pediatric multiple sclerosis. It includes central nervous system involvement via micro and macroangiopathic cerebral changes. Multiple sclerosis ms is a chronic, degenerative disease of the cns that is caused by an immunemediated inflammatory process. Wallace j brownlee, todd a hardy, franz fazekas, david h miller. Background intrathecal igg synthesis itgs, in conjunction with magnetic resonance imaging, can help in the early diagnosis of multiple sclerosis ms. These entities are generally rare, with distinct pathological features, and have a more. This article will discuss the diagnosis of multiple sclerosis ms, with particular attention to differentiating it from other diseases that can mimic it. Recent findings an international panel of multiple sclerosis experts, the ms phenotype group, recently revised the multiple sclerosis phenotypic classifications and published their recommendations in 2014. The european magnims group defined mri red flags in the setting of clinically suspected ms, which suggest that an alternative diagnosis to ms is likely but not in the context of other relevant clinical or laboratory examinations and findings. The heterogeneity of various forms of ssc as well as the multitude of sclerodermalike diseases. This topic will provide an overview and differential diagnosis of papilledema.
Therefore, to identify ms related attacks and determine the final diagnosis is vital for the correct treatment choice and longterm disability prevention. The diagnosis of multiple sclerosis ms relies on the occurrence of characteristic symptoms, on the patients history and on the correct interpretation of nowadays very sensitive but not very. Olek, summarizes the differential diagnosis, clinical features, and prognosis of multiple sclerosis and is the strongest and most important for general physicians. Multiple sclerosis as differential diagnosis of radionecrosis. Recent research developments have helped improve the accuracy of multiple sclerosis diagnosis, especially with regard to differentiating. Multiple sclerosis diagnosis can only be made when there is proof of lesions disseminated in time and in space. The differential diagnosis of ms includes conditions well within the spectrum of iidds as ms as well as other noniidd inflammatory syndromes of the cns. Mri, spinal fluid examination, and evoked potential recordings are. A case report florent guillemina, julian biaua, sakahle condeb, pierre claveloub, guillaume dupica. Recently, we developed a new oligoclonal igg band ocgb test for itgs detection that is more sensitive and easier to interpret than. A conceptual framework for differential diagnosis of ms does not exist.
Neurologic differential diagnosis, 2nd edition, by mark mumenthaler, translated and annotated by otto appenzeller, 1992, georg thieme verlag, stuttgartnew york, 178 pages, dm68. The differential diagnosis of multiple sclerosis journal of. The differential diagnoses can be ruled out by blood tests, mri scans, ctscans, spinal taps etc. Aug 28, 20 fabry disease is a rare xlinked inherited lysosomal storage disorder affecting multiple organ systems. New guidelines for the differential diagnosis of multiple sclerosis could meet their aim of improving the diagnostic accuracy of clinicians who are not specialists in this disorder. In fact, multiple sclerosis was considered the most likely diagnosis in each of these patients before diagnosis of sjogrens syndrome, and each patient met criteria for definite multiple sclerosis. Here is a list of some of the differential diagnoses for multiple sclerosis in no particular order some of these are less severe than ms and some are more so, many are very rare. Oct 08, 2018 multiple sclerosis ms is an acquired idiopathic, inflammatory demyelinating disorder of the central nervous system cns in which the myelin sheath is disrupted due to genetic and environmental factors 1, 2. Mri is of utmost importance in the diagnosis of ms. Diagnosis and differential diagnosis of multiple sclerosis. Psychiatric diseases are mistaken for multiple sclerosis.
Multiple sclerosis 1 diagnosis of multiple sclerosis. Oligoclonal bands and igg are raised in csf of patients with sarcoidosis. Differential diagnosis ms mimics the first requirement for a diagnosis of ms is that the presenting signs and symptoms be consistent with demyelinating disease. In rare instances, the neuropsychiatric form of sle npsle can have a relapsing course and be multifocal in its symptomatology resembling the relapsing. Mean vep latencies were more prolonged in multiple sclerosis 116 ms v 101 ms, p differential diagnosis ms mimics the first requirement for a diagnosis of ms is that the presenting signs and symptoms be consistent with demyelinating disease.
The diagnosis and differential diagnosis of multiple sclerosis. Differential diagnosis of multiple sclerosis and other. This process results in the demyelination of white matter in the brain and spinal cord. Pdf diagnosis of multiple sclerosis ms requires exclusion of diseases that could better explain the clinical and paraclinical findings. Multiple sclerosis ms is a chronic, immunemediated disease of the central nervous system cns that is characterized pathologically by inflammation, demyelination, and, ultimately, axonal loss. Recent findings contemporary diagnostic criteria for ms continue to evolve, while knowledge about diseases that form the differential diagnosis of ms continues to expand. A common misconception is that any attack of cns demyelination means a diagnosis of acute multiple sclerosis ms. The 2010 mcdonald criteria for the diagnosis of multiple sclerosis are widely used in research and clinical practice. Differential diagnosis of multiple sclerosis oxford medicine. In most cases, the diagnosis of multiple sclerosis ms presents few difficulties.
Magnetic resonance imaging in multiple sclerosis magnims network and the consortium of multiple sclerosis centers have given recommendations on the use of mri in ms diagnosis wattjes et al. Jun 18, 2019 multiple sclerosis ms is a chronic, immunemediated disease of the central nervous system cns that is characterized pathologically by inflammation, demyelination, and, ultimately, axonal loss. May 10, 2019 while the term papilledema is often used broadly to denote a swollen optic nerve head, the term papilledema should be reserved for optic disc swelling that is due to raised intracranial pressure. Knowledge about the differential diagnosis of multiple sclerosis is important for a physiotherapist in order to distinguish multiple sclerosis from other conditions that present with almost similar clinical features. The patient presents with the chief complaint of frequent episodes of weakness, and a tingling sensation in different areas of her body. Diagnostic criteria for both multiple sclerosis and neuromyelitis optica spectrum disorder have changed in recent years as new pathological, immunological, imaging, clinical, and therapeutic findings have emerged. Differential diagnosis, clinical features, and prognosis of multiple sclerosis. Clinical evidence of lesions disseminated in time and space, backed up by magnetic resonance imaging mri andor spinal fluid changes, commonly leave neither room nor reason for doubt.
Pediatric multiple sclerosis differential diagnoses. During a lumbar puncture spinal tap procedure, you. The diagnosis of multiple sclerosis is based on neurological symptoms and signs, alongside evidence of dissemination. The diagnosis and differential diagnosis of multiple. The absence of diagnostic tests means that uncertainty can be extremely difficult to resolve. Carmosino mj, brousseau km, arciniegas db, corboy jr. Pdf differential diagnosis of suspected multiple sclerosis.
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