What is a common challenge in diagnosing multiple sclerosis (MS)?

Updated: Oct 08, 2019
  • Author: Christopher Luzzio, MD; Chief Editor: Jasvinder Chawla, MD, MBA  more...
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Answer

Clinicians who specialize in MS commonly see patients referred for multiple, ill-defined, vague complaints and T2 hyperintense lesions on recent head or spinal magnetic resonance imaging (MRI) scans. Careful questioning in these cases reveals that symptoms have been stereotyped and vague or are consistent with other disorders (eg, scintillating scotomas in a patient with concomitant migraines, or hand symptoms consistent with carpal tunnel syndrome). A history of meningoencephalitis during childhood occasionally emerges.

Another common problem is the presence of small T2 hyperintensities on MRI studies of the CNS, typically referred to as unidentified bright objects (UBOs) by neuroradiologists. These nonspecific lesions are relatively common in the general adult population, and clinical correlation (ie, a high degree of suspicion based on clinical evidence) becomes important in the diagnosis. To confirm MS in these cases, the physician should look for sites of involvement that are rare for UBOs but frequent for MS (eg, the corpus callosum or throughout the spinal cord).


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