Multiple Sclerosis (MS) Support Group

LINKS TO:
- 2009 MS Differential Diagnosis.... NEW International Procedure for Diagnosing MS that is free to view NOW, compliments of the NMS but it may become pay per view in the future.

So DOWNLOAD IT TO YOUR COMPUTER NOW!!!!!.....
On the right side of this website, there is a place to click ...Free Full Text(Free PDF)Free

http://msj.sagepub.com/cgi/content...

-2005 Revisions to McDonald Criteria ...MRI Diagnosis of MS. Link is on middle of this page... http://www.msif.org/en/about_ms/di...

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The New 2009 Differential MS Diagnosing Procedure has much new stuff. I will first list the new things I noticed and then describe them more fully below the list.

1. The Overall MS Diagnosing Flow sheet (Procedure).

2. There is no longer a single type of CIS (Clinically Isolated Symptom). Now there are 5 different kinds of CIS.

3. 79 Red Flags, both clinical and MRI that suggested it might not be MS with the possible disease that it could be listed.

4. 3 Typical MS onset areas-Optic Neuritis, Spinal Cord, or Brainstem.

Typical MS onset symptoms (CIS) for each area.
A diagnosing flow sheet that depends on the area of the CIS.

5. Additional information on disease that are commonly mis diagnosed as MS but are not; Devics NMO, ADEM. & Asian OSMS.

6. It does say that MRI findings of “change in normal appearing white matter that may be relatively specific for MS, and high-field MRI to better visualize Dawson’s Finger’s or cortical lesions that may be specific to MS. It has all kind of tips like that in the procedure when you read it

7. 4 Types of MS diagnosis that happen

MS requires proof of time and space. Time that lesions and relapses occur over time, not just a single incident. Space that is in more than 1 area of the CNS.
1. Overall MS Diagnosing Flow sheet.
START with Symptoms Consistent with Inflammatory Demylenation Disease: either monofocal (single symptom) or multifocal (more than 1 symptom).
(A CIS (clinically isolated symptom) generally starts it._
.......THEN exclude any Non-Demylenating Syndrome
...... THEN EITHER (Classify as an UNKNOWN Inflammatory demylenation disease) OR (determine that it is a NON-INFLAMATORY demylenating disease.)
.....STOP if it is a NON-INFLAMATORY demylenating disease. Use Red Flags to help determine which NON-INFLAMATORY disease it might be.
......CONTINUE if it is an UNKNOWN INFLAMATORY demylenating disease
......DETERMINE (if it is not MS but could be Devics NMO or ADEM or unknown)
.....OR....
......DETERMINE (if it is consistent with MS)
......,,EVALUATE how time & space is determined. Could be MRI...McDonald’s Criteria, LP...Spinal Tap, or OCT


2..... 5 Types of CIS (clinically isolated Symptom)
....Type 1 CIS...clinically monofocal (single symptom), at least 1 asymptomatic MRI lesion.
....Type 2 CIS... clinically multifocal (More than 1 symptom), at least 1 asymptomatic MRI lesion.
....Type 3 CIS...clinically monofocal, MRI may appear normal, no asymptomatic MRI lesions.
.....Type 4 CIS...clinically multifocal, MRI may appear normal, no asymptomatic MRI lesions.
.....Type 5 CIS...no clinical presentation to suggest demylenation disease, but MRI is suggestive.

( Type 5 is the new MS type I had read called asymptomatic MS but it has become a CIS)
-------------------------------------------------------------------------------------------------------3..... 79 RED FLAGS. See table of flags and what other disease should be considered. Some Red Flags are diabetes, under age 20, over age 50, no black holes, headache, all lesions enhancing, large infiltrating brain lesion....etc.


4.......Onset areas of ON, Spinal Cord or Brain stem.

ON.... TYPICAL Symptoms.... unilateral visual loss, pain, afferent pupil defect, retrobulbar or mild disc swelling visual loss does not progress past 2 weeks.
ON.... ATYPICAL Symptoms.....no pain, retinal hemorrhages, severe disc swelling, no visual recovery after one month or bilateral visual loss

ON Flowsheet START with ON.
EITHER Typical or Atypical Symptoms...
IF Typical DO a brain MRI.
IF brain MRI is Normal, there is low risk of MS (20%)
IF brain MRI is abnormal and consistent with demylenation there is a High Risk of MS (60-90%) Review McDonald Criteria.
STOP
IF Atypical Symptoms consider other diagnosis. Possible Diagnosis listed
THEN DO other tests....MRI, CFS, OCT, neurophysiological, serologic other studies as appropriate.

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BRIANSTEM....TYPICAL Symptoms....Internuclear opthalmoplegia(double vision),6th nerve palsy, multifocal signs... (e.g. facial sensory loss and vertigo or hearing loss)
BRAINSTEM...ATYPICAL Symptoms...Hyper acute onset, vascular territory sign... (e.g. lateral medullar syndrome, age greater than 50, isolated trigeminal neuralgia, fluctuating occular... bulbar weakness, non remitting, fever,meningism)

BRAINSTEM Flow sheet STARTS with BRAIN STEM CIS
EITHER Typical or Atypical Symptoms
IF Typical DO a Brain MRI
IF brain MRI is Normal, there is low risk of MS (20%)
IF brain MRI is abnormal and consistent with demylenation there is a High Risk of MS (60-90%) Review McDonald Criteria.
STOP
IF Atypical Symptoms consider other diagnosis. Possible Diagnosis listed
THEN DO other tests...MRI, CFS, OCT, neurophysiological, serologic other studies as appropriate.

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SPINAL CORD......Typical Symptoms......Evolution over hours to days, partial myelitis, purely sensory, deafferented upper limb, L.Hermitte sign, Partial Brown-Sequard, Spontaneous remission.
SPINAL CORD....ATYPICAL Symptoms....Hyperacute onset or insidiously progressive, complete transverse myelitis, Radicular pain, Areflexia, Failure to remit.

SPINAL CORD Flow sheet STARTS with SPINAL CORD CIS
EITHER Typical or Atypical Symptoms
IF Typical.... DO a Brain and spinal MRI
IF MRI Normal there is low risk of MS (20%)
IF MRI is abnormal and consistent with demylenation there is a High Risk of MS (60-90%) Review McDonald Criteria.
STOP
IF Atypical Symptoms..... consider other diagnosis. Possible Diagnosis listed
THEN DO other tests...MRI, CFS, OCT, neurophysiological, serologic other studies as appropriate.
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5 and 6...Read procedure to find out what is written about those often misdiagnosed as MS diseases.
7. 4 types of MS diagnosis.
Clinical, laboratory and imaging features that are classic for MS and where no feature strongly suggests an alternative diagnosis. MS is likely. Additional examinations or tests beyond those that satisfy the McDonald criteria for MS are unnecessary
AND
Features that are compatible with MS but occur with the presence of other features... RED FLAGS...that suggest a possible alternative diagnosis. MS can only be diagnosed after tests to exclude alternative diagnosis. In equivalent situations, repeated imaging and laboratory tests over a period of observation may be advisable before reaching a conclusive diagnosis.
AND
Clinical and, or paraclinical findings red flags that point to a nonMS diagnosis. MS is improbable. Efforts should be directed at defining the alternative condition, especially when treatable.
AND
Clinical and, or paraclinical findings that suggest the presence of MS with another superimposed disorder. Appropriate imaging and laboratory tests should be preformed to confirm the coexistence of two conditions.
Posted on 06/18/09, 08:06 pm