On Diagnosis MS (also in group files)

[Guest guest]

Not all doctors agree on what a diagnosis of MS consists of. Here issome links and info I found for you. I'm just copying small bits fromeach but the link is there for you to read more from each site.hugs))Sharon*********http://www.medscape.com/viewarticle/516519The revised MRI criteria for dissemination in space are three of thefollowing: one or more gadolinium-enhancing lesions or nine T2hyperintense lesions; one or more infratentorial lesions; one or morejuxtacortical lesions; or three or more periventricular lesions.The revised criteria for diagnosis of MS include the following:

At least two attacks with objective clinical evidence of at least two lesions;At

least two attacks with objective clinical evidence of one lesion plus

dissemination in space shown on MRI or two or more MRI lesions

consistent with MS plus positive CSF finding or second clinical attack;One attack with objective clinical evidence of at least two lesions plus dissemination in time on MRI or second clinical attack;One

attack with objective clinical evidence of one lesion, plus

dissemination in space shown on MRI or two or more MRI lesions

consistent with MS plus positive CSF finding and dissemination in time

shown on MRI or second clinical attack;Insidious neurologic

progression suggestive of MS plus one year of disease progression

determined retrospectively or prospectively and two of the following:

positive brain MRI result (nine T2 lesions or at least four T2 lesions

with positive Visual Evoked Potential), positive spinal cord MRI result

with two focal T2 lesions, and positive CSF findings.

*********http://www.clevelandclinic.org/health/health-info/docs/1900/1908.asp?index=8460

What are the accepted criteria for diagnosis?

Onset usually between 10 and 60 years of ageSymptoms and signs indicating lesions of central nervous system white

matterEvidence of two or more lesions upon examination by MRI scan (see

below)Objective evidence of central nervous system disease on neurological

examinationA course following one of two patterns: two or more episodes lasting

at least 24 hours and occurring at least one month apart, or a

progressive course of signs and symptoms over at least six monthsNo other explanation for the symptoms

*********http://www.mult-sclerosis.org/DiagnosticCriteria.html (this one has a big chart so you'll have to look at it)

*********http://library.med.utah.edu/kw/ms/dc.html

General Diagnostic Criteria

Multiple Sclerosis can be difficult to diagnose. Although no

neurological symptoms or findings are pathognomonic for MS, certain

important clues can be found during history and/or physical exam that

will lead to the correct diagnosis.

Intranuclear ophthalmoplegia is rarely found in young adults

in diseases other than MS.

Altered color vision in one eye, optic pallor and/or Marcus-Gunn pupil

(relative afferent pupillary defect) may all be signs of optic neuritis and can provide information on subclinical or resolved optic neuritis.

Many different types of nystagmus are common findings in patients with MS.

A mild intention tremor can be another early sign of MS.

Slight motor weakness and spasticity may be found.

Positive Romberg's sign, decreased vibratory and proprioceptive sense in lower extremities may also be seen in early MS

A middle-aged or young adult presenting with Lhermitte's sign

should undergo a very careful neurologic examination to rule out

possible MS. (Lhermitte's sign is present if a patient complains of

paresthesia or electric shock-like sensation which radiates down long

the length of the spine or up through the head upon flexing the neck.)

Standard Criteria for Diagnosis

At present there are no tests in which an abnormality is specific for

MS. Nonetheless, clinical examinations and diagnostic testing including

MRI, lumbar puncture and evoked potentials are very helpful. The

following standard diagnostic criteria developed by Poser et al., are

commonly used:

Criteria for DiagnosisDiagnostic Categories

History of two attacks with positive

oligoclonal bands or increased IgG in CSF; no clinical or para clinical

evidence of a diseaseProbable MS with laboratory support

History of two attacks without laboratory abnormalitiesClinically probable MS

History of two attacks with clinical and para clinical evidence of one lesion; Oligoclonal bands or increased IgG present in CSFLaboratory-supported definite MS

History of at least two attacks; Clinical

evidence of at least one lesion and clinical or para clinical evidence

of another lesionClinically-definite MS

*********

DIAGNOSING MS

The Neurologist requires clinical evidence that your Neurological deficits, indicate involvement of at least TWO different areas (Functional Systems) of the CNS, with documented Neurological Signs occurring at TWO separate and distinct time periods; and ALL other possible Neurologic causes must have been eliminated. ("Poser Criteria")1 - Poser, C.M.; Paty, D.W.; Mc, W.I.; Scheinberg, L.; Ebers. G.C.; eds."The Diagnosis Of Multiple Sclerosis" New York: Thieme-Stratton Inc.; 19842 - Poser CM, Paty DW, Scheinberg L, et al."New Diagnostic Criteria For Multiple Sclerosis: Guidelines For Research Protocols"Ann Neurol 1983;13:227-231Multiple Sclerosis is essentially a clinically determined diagnosis of exclusion. There are NO tests which are specific for MS, and NO single test is 100% conclusive. Conventional MRIs only image some lesions (Macroscopic ones), which are NonSpecific as to cause and

do NOT fully account for MS.Therefore, several tests and procedures are needed to eliminate ALL other possible causes and firmly establish a diagnosis of MS. They include the following:· Diagnostic Categories· Medical History· Neurological Examination · Evoked Potentials · Magnetic Resonance Imaging · Lumbar Puncture (Spinal Tap)

*********

http://www.msnews.org/faqmri.shtmlQuestions answered by Dr. Herman WeintraubQUESTION: I had my third MRI in five years and this one had one 4mm lesion in the front left lobe, with hyperintensities in periventricular areas. The radiologist reported it as normal for a female 41 years of age. Why? Do they leave this in the hands of the

neurologist, who has the history and physical info on the patient to diagnose? The other two MRI's showed nothing. 10/11/99 ANSWER: The only person who can properly interpret your MRI is your neurologist. A radiologist can suggest various possibilities for a lesion, but it is up to the doctor who knows your history and exam to decide whether a finding is normal or abnormal. There are some age-related changes in the brain that can sometimes mimic or overlap with MS lesions, but these usually do not appear until the 50s or 60s; you're too young for these lesions! & #65532;QUESTION: What is the difference between white

matter and gray matter? What significance is a finding of lesions in both on an MRI? I'm newly diagnosed with MS. 8/6/99 ANSWER: White matter includes the pathways that contain myelin, allowing the nerve cells to talk to one another. The gray matter is the thinking part of the brain; it contains the cells that do the hard work of generating electrical impulses. It is not appreciated that there is white matter (myelin) in the gray matter; MS lesions can involve the gray matter at times, sometimes confusing neurologists and their patients. It is unusual but not unheard of to see typical MS type lesions occasionally involving the gray matter. & #65532;QUESTION: I have vision and

bladder problems, tingling, balance, speech and numbness with my MS. I’m presently taking Avonex injections. I was diagnosed with MS 2 years ago and have since changed to another neurologist. The new neuro said my lesions have not changed in two years and thinks that I do not now have MS. Must there be a change in lesions or can they stay the same? 7/10/98 ANSWER: It is not unusual for brain MRI lesions to plateau and remain unchanged between MRIs. This does not in any way contradict the diagnosis of MS. It does suggest that the “burden†of disease accumulation has slowed. & #65532;QUESTION: I am undiagnosed,

but my MRI reads "subtle linear hyperintensities in the deep white matter adjacent to the ventricular atria". Can you explain this? 7/1/99 ANSWER: MRI changes consistent with MS include hyperintensities on the T2-weighted images. These are often in the are around the ventricles, which would include the ventricular atria. There is a differential diagnosis that accompanies these white spots: these can be seen in demyelinating disease (MS) but also with normal aging, strokes, infections, etc. You are entitled to review your MRI film with your neurologist or the physician who ordered it. & #65532;QUESTION: I have had 2

MRI's with atypical positive findings in the corpus callosum. I was first diagnosed with MS 2 years ago with left sided weakness and paralysis, bilateral ON, bladder and diaphragm spasticity. I have been getting progressively worse over the last 11 months and have been unable to work. I now have cognitive deficits. Can you explain corpus callosum involvement and if it causes speech, word retrieval, memory loss, confusion, and poor reading comprehension? I would like to go to law school but unable to stabilize.5/4/99 ANSWER: The corpus callosum is a common site of involvement in MS by MRI, but it is not a site where we can clearly localize specific neurologic findings. Some authorities consider it a "silent area" of the brain, where a person can develop sizable growths, such as brain tumors, without much

finding on the physical neurologic exam. As you point out, the corpus callosum is a pathway for transferring information between the right and left brains, so it is a critical linkage in the brain's information highway. There is MRI evidence indicating that corpus callosum atrophy is better correlated with cognitive dysfunction in MS than physical dysfunction. & #65532;QUESTION: I have had repeated brain MRIs. All have been negative. However, symptoms and neurological exams repeatedly confirm that I have MS. I have been diagnosed for 15yrs, with relapses about twice a year. Why are the MRIs still normal?3/10/99 ANSWER: A

small proportion, probably < 5% of persons with clinically definite MS may have persistently normal MRIs. Another possibility is that the disease involves the cervical or thoracic spine, which is often not imaged, and which sometimes is of poor resolution to pick up a plaque. I recently had the experience of a patient who underwent an "open MRI" for fear of claustrophobia; this was interpreted as negative. The brain MRI showed some suspicious lesions and she actually underwent brain biopsy. The biopsy was consistent with MS. When she had a "closed MRI," with appropriate sedation to prevent claustrophobia, the MS lesions appeared. Finally, there is the possibility that you don’t have MS, but something that can mimic it, like lupus or other syndromes. MS is still a clinical diagnosis, based on signs and symptoms. No specific lab test can make or break the diagnosis. & #65532;QUESTION: On my last MRI I had a report come back of a 1 cm X 5-mm focal area of increased signal present in the right globus pallidus. It appears to abut the posterior limb of the right internal capsule and putamen. The report says there is fluid now collected in it and it could be ischemia or a focal area of demyelinization. My neurologist says he believes it to be an old area of attack of MS plaque that has filled with water. I had another dr. (not a neurologist) tell me I should be checked for strokes. I have no head injuries. My question is, can MS plaques do this or should I be checking for vascular problems? Any help on this will be much appreciated. 7/10/98 ANSWER: Your

neurologist is likely correct. If there is tissue loss anywhere in the brain, that area is eventually filled up with CSF (brain water). There are only three things in the brain—brain tissue (the "salami"), blood, and spinal fluid. If brain tissue is lost, for whatever reason, the spinal fluid takes its place. & #65532;QUESTION: I was diagnosed with MS about 15 months ago through symptoms, MRI, blood test, and spinal tap. Lesions have appeared on every one of my MRIs. The last MRI showed lesions but ones that were not "active." Currently I am experiencing ON in my right eye. I am feeling sharper pains behind my eye this time compared to my first ON experience. My MRI scan however, did not pick up any change from five months ago. Is it possible to

have an exacerbation and not see a new or active lesion on the MRI?7/10/98 ANSWER: There are limitations to the sensitivity of the MRI to detect new lesions. It has become apparent that gadolinium enhancement reflects blood-brain-barrier breakdown with the formation of new lesions. However, established lesions can enlarge on their own without obvious evidence of gadolinium enhancement. We think now that once lesions become established within the brain, they take on a life of their own, and can activate and de-activate based on as yet unidentified signals. So the answer to your question is that it’s quite possible to have a flare-up of MS representing activation of an established lesion even without evidence of gadolinium enhancement.

Be a better friend, newshound, and know-it-all with Yahoo! Mobile. Try it now.