Typical Presentations Of Ms
The three most common presentations of MS are transverse myelitis, optic neuritis, and brainstemcerebellar dysfunction. Acute partial transverse myelitis is the most classic form of transverse myelitis among patients with MS, said Dr. Pawate. Acute complete transverse myelitis, on the other hand, may be postinfectious or idiopathic, or seen as part of acute disseminated encephalomyelitis . Similarly, longitudinally extensive transverse myelitis is more suggestive of neuromyelitis optica spectrum disorders than MS.
The most typical presentation of MS optic neuritis is unilateral and has acute or subacute onset. Patients often have retrobulbar, gritty pain when they move their eye. Complete blindness is unusual, and complete recovery occurs in nearly all patients. Hyperacute onset suggests a vascular process rather than optic neuritis, said Dr. Pawate. Slow, insidious onset may indicate an infiltrative process such as neoplasm or sarcoidosis. Painless vision loss may indicate ischemic optic neuropathy, and severe blindness without recovery may result from NMOSD.
Why Do People Get Ms
It’s not clear what causes the immune system to attack the myelin sheath.
It seems likely that it’s partly caused by genes you inherit from your parents and partly by outside factors that may trigger the condition.
Some of the factors that have been suggested as possible causes of MS include:
- your genes MS isn’t directly inherited, but people who are related to someone with the condition are more likely to develop it the chance of a sibling or child of someone with MS also developing it is estimated to be around 2-3%
- lack of sunlight and vitamin D MS is more common in countries far from the equator, which could mean that a lack of sunlight and low vitamin D levels may play a role in the condition, although it’s not clear whether vitamin D supplements can help prevent MS
- smoking people who smoke are about twice as likely to develop MS compared to those who don’t smoke
- viral infections it has been suggested that infections, particularly those caused by Epstein-Barr virus , might trigger the immune system, leading to MS in some people
More research is needed to further understand why MS occurs and whether anything can be done to prevent it.
Does Ms Show Up On A Brain Mri
MRI technology can detect MS lesions. This type of scan is used to diagnose MS as well as monitor its progression by keeping track of any new lesions that may have occurred since diagnosis.
An MRI scan can also reveal if any existing lesions have increased in size. In addition, it allows doctors to monitor the location of lesions and the areas of the brain that may be potentially affected.
The specific location of lesions may also give doctors information about possible related cognitive issues to watch for.
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What Causes Brain Lesions In People With Multiple Sclerosis
Lesions in multiple sclerosis are the result of damage to the cells of the central nervous system, which is made up of the brain and spinal cord. Sclerosis refers to the characteristic scar tissue that forms in lesions in the brains of people who have MS. MS lesions are also known as scleroses or plaques.
What Causes Brain Lesions
Symptoms of a brain lesion depend upon what part of the brain is affected. Large parts of the brain can be involved in some diseases and there may be relatively few symptoms. Alternatively, very tiny lesions may be catastrophic if they occur in a critical part of the brain. For example, the reticular activating system is a tiny area located within the brainstem that is effectively the master on/off switch of the brain. If a midbrain stroke affects this area, the result is permanent coma. A patient needs the RAS and one functioning hemisphere of the cortex to be awake. If the patient is unconscious, then the RAS isn’t working or there is significant damage to both sides of the brain.
Initial signs and symptoms of a brain lesion are often non-specific and may include:
The diagnosis of a brain lesion begins with the health care practitioner taking a history and asking the patient questions about the symptoms such as:
- When did they start?
- Do they come and go or are they constant?
- Have they progressed over time?
- What makes them better or worse?
Depending upon the circumstances, the patient may not have insight or may not remember the symptoms or complaints, and it may be up to a family member, caregiver, or friend to supply the appropriate information.
Medical history and physical exams
Past medical history of the patient, exploring associated symptoms and complaints may be helpful in determining the diagnosis.
Imaging and other tests
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Can A Brain Mri Show Multiple Sclerosis Lesions
One additional caveat concerns the scenario when, contrary to expectations, brain MRI, in a patient with improbable MS, shows findings suggestive of MS .
I was diagnosed in 2005 too. Nowadays the basilar and exhaustive tests for MS are, besides your clinical story, an MRI scanto brain AND spinal cord for research of MS lesions or scars, and a lumbar puncture as well to determine whether you have oligoclonal bands in your cerebrospinal fluid. That is an important indicator in the diagnosis of MS.
The author argues that in a patient with no clinical history of MS-like relapses and a normal neurologic examination improbable MS the absence of lesions typical for demyelination makes the diagnosis of MS untenable.
Research And Statistics: Who Has Ankylosing Spondylitis
Data from the U.S. National Health and Nutrition Examination Survey estimated that up to 1 percent of adults in the United States may have spondyloarthritis, a broad term that describes types of arthritis that affect the spine, including ankylosing spondylitis. Other groups have projected the number of people with AS to be approximately 1.1 million to 2.7 million Americans.
While anyone can be diagnosed with AS, those who are usually have the following characteristics:
Young to middle age Most people with ankylosing spondylitis have their first symptoms between the ages of 20 and 40, although about 10 to 20 percent have symptoms before age 18.
Race Ankylosing spondylitis occurs more frequently in Caucasians, while African Americans usually have more severe disease.
Gender AS is more common in men than in women. Recent estimates suggest it occurs in two to three men for every woman with AS. There is some concern that women may be underdiagnosed because of different symptoms.
Genes Genetics appear to play a role in ankylosing spondylitis. Specifically, people who have a gene that produces a protein called HLA-B27 are at a significantly higher risk of being diagnosed, although only some with this gene actually get AS. Researchers conclude that a combination of genetic and environmental factors are necessary to trigger ankylosing spondylitis. First-degree relatives of an affected person have a higher risk than the general population.
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Conditions That Mimic Multiple Sclerosis
is a hard disease to diagnose. If you have symptoms of MS and go to an MS treatment center, there’s about a 50% chance that you will not receive a diagnosis of MS. Thats because lots of other conditions mimic MS. In fact, one criterion for an MS diagnosis is that your doctor must rule out the other suspects.
Doctors develop a differential diagnosis when they think several possible diseases or conditions could be causing symptoms. With MS, there are lots of possibilities that doctors must consider. They include blood vessel problems, infections, other , vitamin deficiencies, and inherited conditions. It can take time and lots of testing to establish an accurate diagnosis.
How Do You Rule Out Ms
Neurological exam There are no specific tests for MS . 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. Your doctor is likely to start with a thorough medical history and examination.
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Early Signs Of Multiple Sclerosis
An expert explains which symptoms to watch for and the benefits of early treatment
Multiple sclerosis is the ultimate chameleon.
This chronic, inflammatory autoimmune disease affects the central nervous system, resulting in damaged nerves and scar tissue formation, so it can resemble a multitude of other illnesses. This also makes it incredibly hard to detect. And the fact that no two people with MS experience the same symptoms only adds to its unpredictability.
Here’s what makes it so tricky: Your brain and spinal cord are full of nerves that send electrical signals rapidly to all areas of your body, which allow you to walk, talk, see, swallow and much more. These nerves are coated in a sheath called myelin that helps transmit the signals.
With MS, the myelin gets destroyed because your immune system mistakenly tells your body to attack it, causing scarring or sclerosis and signal interruption. As a result, those with MS experience a variety of different symptoms depending on which signals get interrupted.
“Because MS can develop anywhere within the central nervous system and encompasses the optic nerves, the brain and the spine, a lot of different types of critical attacks can occur, so that leads to diagnostic complexity,” says Thomas Shoemaker, MD, a neurologist and MS expert at the Rush Multiple Sclerosis Center.
Can You Prevent Brain Lesions
Scientists are still looking for ways to protect against brain lesions. They think keeping your migraines in check can help. Having frequent attacks is linked with a higher risk of lesions, so fending off migraines or treating them early on may help lower your risk. These simple steps could help:
- Talk to your doctor. You may need to take medicine or get treatments, like Botox injections, to head off migraines.
- Know your triggers. Bright lights, weather changes, and certain foods could set off your migraines. Once you know your triggers, you can learn to avoid them.
- Keep a lid on stress. Make time to unwind and do things you enjoy every day.
- Get moving. Exercise eases tension and boosts blood flow to the brain, which can help stave off headaches. Research also shows that physical activity may prevent white matter lesions.
- Practice good sleep habits. A bad night could set off an attack. Try to go to bed and wake up at around the same time.
American Migraine Foundation: âMigraine and Brain Lesions.â
Cleveland Clinic: âBrain Lesions.â
Mayo Clinic: âBrain Lesions,â âMigraine,â âMigraine with Aura,â âMigraines: Simple steps to head off the pain,â âPatent foramen ovale.â
Neurology: âMigraine and Structural Changes in the Brain,â âPhysical Activity, Motor Function, and White Matter Hyperintensity Burden in Healthy Older Adults.â
Dana Foundation: âWhy the White Brain Matters.â
American Stroke Association: âSilent Stroke.â
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Determining The Type Of Ms
Once a diagnosis of MS has been made, your neurologist may be able to identify which type of MS you have.
This will largely be based on:
- the pattern of your symptoms such as whether you experience periods when your symptoms get worse then improve , or whether they get steadily worse
- the results of an MRI scan such as whether theres evidence that lesions in your nervous system have developed at different times and at different places in your body
However, the type of MS you have often only becomes clear over time because the symptoms of MS are so varied and unpredictable. It can take a few years to make an accurate diagnosis of progressive MS, as the condition usually worsens slowly.
Conversion And Psychogenic Disorders
Conversion and psychogenic disorders are conditions in which psychological stress is converted into a physical problem such as blindness or paralysis for which no medical cause can be found. In a study published in September 2016 in the journal Neurology, 11 percent of subjects definitely or probably misdiagnosed with MS actually had a conversion or psychogenic disorder.
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Benign Brain Tumor Symptoms & Signs
Symptoms of benign brain tumors often are not specific. The following is a list of symptoms that, alone or combined, can be caused by benign brain tumors unfortunately, these symptoms can occur in many other diseases:
- vision problems
- changes in mental ability
- seizures, muscle jerking
- change in sense of smell
When Does Ms Get Bad
The change may happen shortly after MS symptoms appear, or it may take years or decades. Primary-progressive MS: In this type, symptoms gradually get worse without any obvious relapses or remissions. About 15% of all people with MS have this form, but its most common type for people diagnosed after age 40.
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Cognitive Symptoms And Decline In Ms
MS lesions in both the brain and spinal cord can cause a wide range of physical symptoms, including trouble with moving muscles, numbness and tingling, and reduced bladder control. But lesions in the brain and especially brain gray matter atrophy in the brain can also cause cognitive symptoms.
Cognitive symptoms in MS are often related to memory, says Cross but not forgetting skills or information in the way that someone with dementia would. Instead, many people with MS have trouble with multitasking, keeping two or three things going in their mind at the same time, she explains.
People who have MS may also experience reduced visual or verbal memory. One of the tests I like to use is to take the word world and ask patients to put the letters in alphabetical order, without using a piece of paper, says Cross.
Blogger at Girl with MS
Using Mri To Diagnose Ms
MRI scans provide a significant amount of information that doctors use to diagnose MS and assess the status of people with the condition.
These scans can detect damage in the central nervous system, which comprises the brain and spinal cord. MS-related lesions appear on MRI images as either bright or dark spots, depending on the type of MRI used.
This imaging technique is useful because it shows active inflammation and helps doctors determine the age of the lesions. Also, some specific types of lesion can indicate a flare-up of MS or damage in the brain. It is a good idea for anyone with MS to have regular scans so that a doctor can assess the progression of the disease.
Below, we list some of the main MRI scanning techniques.
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What Causes Spine Lesions
Spine lesions are commonly found in people with MS. One study found that in 104 people recently diagnosed with MS, 83 percent had spine lesions. In MS, immune cells attack the fatty coating on the outside of nerve cells. This nerve coating is known as myelin. When damage occurs, it leaves behind scar tissue that forms into lesions on the brain and spinal cord. These lesions are called plaques.
The spine contains 33 individual bones and is divided into five distinct regions:
- Cervical, starting at the base of the head through the neck
- Thoracic, starting at the base of the neck through the middle of the back
- Lumbar, spanning the lower back
- Sacral, spanning the pelvis
- Coccyx, the tailbone
Spine lesions in MS are usually found in the cervical region. Occasionally, they can be found in the thoracic region. One study even found that the presence of cervical lesions predicts the involvement of the thoracic region in MS. Other causes of spine lesions can include:
- Neuromyelitis optica spectrum disorder
- Congenital defects
How Ankylosing Spondylitis Causes Aortic Regurgitation
Some people with AS develop chronic inflammation at the base of the heart, around the aortic valve, and at the origin of the aorta, the main artery that carries blood away from the heart.
Years of chronic inflammation can lead to aortic regurgitation, a condition that occurs when the aortic valve doesn’t close properly, causing blood to flow backward.
A study published in November 2015 in the American Journal of Medicine reported aortic regurgitation may cause symptoms such as dyspnea uncomfortable or labored breathing as well as reduced physical capacity and fatigue that might be wrongly interpreted as symptoms related to a persons ankylosing spondylitis, not to heart problems. 00443-X/fulltext” rel=”nofollow”> 10)
In this particular study, aortic regurgitation was found in 18 percent of the participants with ankylosing spondylitis. In addition, aortic regurgitation was associated with both age and severity of ankylosing spondylitis.
The researchers suggest that routine care in ankylosing spondylitis include monitoring with both echocardiography and electrocardiography. Once diagnosed, symptomatic aortic regurgitation can be treated with medication or by surgical repair or replacement.
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Limitations Of The Checklist Approach
The MS Lesion Checklist reflects the authors experience and literature review and is not yet validated. Developed by a clinician for clinicians, it is designed as a quick and practical tool for trying to determine whether MRI findings support a diagnosis of MS. The MS Lesion Checklist is not intended to replace review by qualified neuroradiologists that takes into account a full range of features that may help discriminate MS from other causes and assesses for presence of a wide variety of pathologic processes.12-,13 A third limitation is availability and quality of relevant MRI images for review. If a patients scan parameters deviate materially from the recommended MRI protocol for MS,14 comprehensive evaluation for demyelinating lesions may not be possible.
What Are The Symptoms Of Brain Lesions
Symptoms of brain lesions vary depending on the type of lesion, its extent, and where it is found. Everyone is different and symptoms will vary in individual cases. Many lesions, however, may be in areas of the brain that dont produce symptoms.
Typical symptoms may include:
- Headaches are usually the first symptom to appear with brain lesions. The pain appears suddenly and worsens as time passes. Over-the-counter medicine usually offers no relief for the pain.
- Nausea and possible vomiting
- Impaired movement, if the lesion affects the part of the brain responsible for motor skills
- Lack of concentration, the inability to make quick decisions, and agitation
- Delayed speech, blurred vision, and impaired hearing
- Involuntary movements of body parts, which may progress to convulsions in severe cases
The following symptoms are specific to lesions of the frontal lobe:
- Absence of sense of smell, usually limited to one nostril
- Speech impairment
- Loss of motor activity on one or both sides of the body
- Behavioral changes
The following symptoms are specific to lesions of the temporal lobe:
- A change in behavior and emotions
- Disruption in the sense of smell, taste, and hearing
- Language and speech disorders
- Problems with field of vision
- Forgetfulness and the inability to focus
The following symptoms are specific to lesions of the parietal lobe:
- Loss of sensations like touch
- Astereognosis, or the inability to identity things placed in the hand
- Weakening of language development
- Changes in vision
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