Neuromyelitis optica spectrum disorder nmosd acute disseminated encephalomyelitis adem. It includes central nervous system involvement via micro and macroangiopathic cerebral changes. Due to its clinical symptoms and frequent mri lesions, fabry disease is commonly misdiagnosed as multiple sclerosis. These entities are generally rare, with distinct pathological features, and have a more. A systematic process for exclusion of alternative diagnoses has not been defined. Pdf diagnosis of multiple sclerosis ms requires exclusion of diseases that could better explain the clinical and paraclinical findings. The 2010 mcdonald criteria for the diagnosis of multiple sclerosis are widely used in research and clinical practice.
This process results in the demyelination of white matter in the brain and spinal cord. The heterogeneity of various forms of ssc as well as the multitude of sclerodermalike diseases. The diagnosis of ms is a clinical diagnosis, meaning that the. Multiple sclerosis diagnosis can only be made when there is proof of lesions disseminated in time and in space. Differential diagnosis of multiple sclerosis request pdf. Multiple sclerosis as differential diagnosis of radionecrosis. 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. Angiotensinconverting enzyme determination may be used for further differential diagnosis. It may be elevated in either serum or csf but is not reliably abnormal. The ideal diagnosis schema would be able to determine for any given subject, if he will develop ms, at any point in his life, and when.
For a course for continuing education interest in topic surfing the web. The differential diagnosis of multiple sclerosis journal of. Central nervous system involvement and the course of the disease may show striking similarity to ms. 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. This pretty much includes any pathological process that can reflect injury to the central. Aug 28, 20 fabry disease is a rare xlinked inherited lysosomal storage disorder affecting multiple organ systems. Differential diagnosis of multiple sclerosis neurology. Background intrathecal igg synthesis itgs, in conjunction with magnetic resonance imaging, can help in the early diagnosis of multiple sclerosis ms. Relapsing remitting ms is the most common type, and typical symptoms.
How useful is the online multiple sclerosis tutorial. 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. Guidelines for differential diagnosis of suspected. 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. Importantly, adem is a diagnosis of exclusion necessitating a search for alternative etiologies. Wallace j brownlee, todd a hardy, franz fazekas, david h miller. The basic pathological data for ms have been unveiled by the histopathological studies started by carswell in 1838, and cruveilhier. Diagnosis and differential diagnosis of multiple sclerosis. 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.
Overview and differential diagnosis of papilledema uptodate. 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. 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 contemporary diagnostic criteria for ms continue to evolve, while knowledge about diseases that form the differential diagnosis of ms continues to expand. Multiple sclerosis diagnosis and treatment mayo clinic. Multiple sclerosis ms is the most common demyelinating disease of the central nervous system cns and it has a genetic susceptibility noseworthy et al.
The views and discussions in the book are fresh and uptodate. In most cases, the diagnosis of multiple sclerosis ms presents few difficulties. 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. Other tests include visual evoked potentials vep and analysis of spinal fluid taken by lumbar puncture. Multiple sclerosis ms is the most common permanently disabling disorder of the central nervous system in young adults. Pediatric multiple sclerosis differential diagnoses. Early differential diagnosis of multiple sclerosis using a. 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. Recent research developments have helped improve the accuracy of multiple sclerosis diagnosis, especially with regard to differentiating. Pdf differential diagnosis, clinical features, and. Pdf the diagnosis of multiple sclerosis ms relies on the occurrence of characteristic symptoms, on the patients history and on the correct. Classification, diagnosis, and differential diagnosis of.
Differential diagnosis of suspected multiple sclerosis. It is also the most common cause of neurological disability in young adults. Oligoclonal bands and igg are raised in csf of patients with sarcoidosis. 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. Occasionally, however, a rogue erythrocyte sedimentation rate esr, an atypical or normal mri scan, or an unexpected symptom. In rare instances, the neuropsychiatric form of sle npsle can have a relapsing course and be multifocal in its symptomatology resembling the relapsing. Classification, diagnosis, and differential diagnosis of mul.
Differential diagnosis of multiple sclerosis sciencedirect. Mri of the brain may reveal atrophy, cortical and deep gray matter lesions related to ischemia fig. This question is for testing whether or not you are a human visitor and to prevent automated spam submissions. Carmosino mj, brousseau km, arciniegas db, corboy jr. Background and objectives diagnosis of multiple sclerosis ms requires exclusion of diseases that could better explain the clinical and paraclinical findings. Diagnosis of multiple sclerosis ms requires exclusion of diseases that could better explain the clinical and paraclinical findings. This topic will provide an overview and differential diagnosis of papilledema. 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.
Differential diagnosis of multiple sclerosis 2092 words. Differential diagnosis of multiple sclerosis and other. 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 and other inflammatory. Initial evaluations for multiple sclerosis in a university multiple sclerosis center. Recent research developments have helped improve the accuracy of multiple sclerosis diagnosis, especially with regard to. Differential diagnoses multiple sclerosis case study. Pdf differential diagnosis of suspected multiple sclerosis.
Differential diagnosis of multiple sclerosis 884 words 4 pages. A common misconception is that any attack of cns demyelination means a diagnosis of acute multiple sclerosis ms. The diagnosis of multiple sclerosis and its many differential diagnoses can still be challenging but progress continues to be made. Your doctor is likely to start with a thorough medical history and examination. 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. 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. Fabry disease is a rare xlinked inherited lysosomal storage disorder affecting multiple organ systems. Differential diagnosis ms mimics autoimmuneinflammatory conditions. The patient presents with the chief complaint of frequent episodes of weakness, and a tingling sensation in different areas of her body. 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. Therefore, to identify ms related attacks and determine the final diagnosis is vital for the correct treatment choice and longterm disability prevention. 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.
Multiple sclerosis ms is a chronic, degenerative disease of the cns that is caused by an immunemediated inflammatory process. Pdf the differential diagnosis of multiple sclerosis. Patient family friend of patient physician nurse medical student nursing student undergraduate k12 faculty other please specify. 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 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. 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.
Myelin damage and the nervous system mayo clinic, 2017 rationale. Differential diagnosis, clinical features, and prognosis of multiple sclerosis. 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. Case report multiple sclerosis as differential diagnosis of radionecrosis for postirradiation brain lesions. Diagnosis and management of multiple sclerosis american. Therefore, when damage in the cns is big enough to be seen. Psychiatric diseases are mistaken for multiple sclerosis. Scientific advances in the past 7 years suggest that they might no longer provide the most uptodate guidance for clinicians and researchers. Multiple sclerosis knowledge for medical students and.
Olek, summarizes the differential diagnosis, clinical features, and prognosis of multiple sclerosis and is the strongest and most important for general physicians. During a lumbar puncture spinal tap procedure, you. 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. The majority of patients with ms will have muscle weakness in their extremities as well as paresthesias. Recently, we developed a new oligoclonal igg band ocgb test for itgs detection that is more sensitive and easier to interpret than. Apr 25, 2020 what are the differential diagnoses for multiple sclerosis.
The differential diagnoses can be ruled out by blood tests, mri scans, ctscans, spinal taps etc. 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. This article discusses approaches to the clinical assessment for ms that may improve diagnostic accuracy. Pdf diagnosis and differential diagnosis of multiple. 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.
The diagnosis and differential diagnosis of multiple. Mri, spinal fluid examination, and evoked potential recordings are. The most important tools are the medical history, a careful and thorough neurologic exam, and magnetic resonance imaging mri. Fabry disease underestimated in the differential diagnosis.
Differential diagnosis ms mimics the first requirement for a diagnosis of ms is that the presenting signs and symptoms be consistent with demyelinating disease. 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. Evoked potential studies in the antiphospholipid syndrome. Mri is of utmost importance in the diagnosis of ms. Neurologic differential diagnosis pdf free download. Multiple sclerosis ms is the most common acquired demyelinating disorder of the central nervous system cns. The diagnostic criteria for multiple sclerosis ms have been continuously evolved since 1950s, and gained speed parallel to the development of detailed. Differential diagnosis of multiple sclerosisfebruary 22, 1999 1 homework 5. 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. The diagnosis and differential diagnosis of multiple sclerosis.
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. Current 2017 mcdonald diagnostic criteria for multiple sclerosis include clinical, imaging and laboratory findings thompson et al. What are the differential diagnoses for multiple sclerosis. 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. A clinical approach to the differential diagnosis of multiple sclerosis. Miller1,5 fmedsci 1 queen square multiple sclerosis centre, ucl institute of neurology, london, united kingdom. There are a number of illnesses that can mimic multiple sclerosis ms. Differential diagnosis of pediatric multiple sclerosis. An international panel of ms experts developed consensus perspectives on ms differential diagnosis. Multiple sclerosis 1 diagnosis of multiple sclerosis. 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. Ms has a higher prevalence among women and people in temperate regions such as europe and north america. 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.
The diagnosis of multiple sclerosis is based on neurological symptoms and signs, alongside evidence of dissemination. The absence of diagnostic tests means that uncertainty can be extremely difficult to resolve. Differential diagnosis of scleroderma and pseudoscleroderma. Differential diagnosis of multiple sclerosis oxford medicine. Diagnosis, differential diagnosis, and misdiagnosis of. The differential diagnosis of multiple sclerosis journal. A case report florent guillemina, julian biaua, sakahle condeb, pierre claveloub, guillaume dupica. Neurologic differential diagnosis, 2nd edition, by mark mumenthaler, translated and annotated by otto appenzeller, 1992, georg thieme verlag, stuttgartnew york, 178 pages, dm68.
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