What are the diseases that mimic Multiple Sclerosis symptoms. How can medical professionals differentiate between MS and similar conditions. Why is accurate diagnosis crucial for proper treatment of neurological disorders.

Understanding the Diagnostic Challenges of Multiple Sclerosis

Multiple Sclerosis (MS) diagnosis presents a significant challenge for medical professionals. A recent study published in Multiple Sclerosis and Related Disorders revealed that nearly 20% of individuals with other neurological conditions are incorrectly diagnosed with MS. This high rate of misdiagnosis stems from the absence of a definitive test for MS and the variability of its symptoms.

Why is MS so difficult to diagnose accurately? The answer lies in its complex nature and symptom overlap with other conditions. Common MS symptoms include numbness, tingling, pain, fatigue, and heat sensitivity. However, not all patients experience the full range of symptoms, and these manifestations can mimic other neurological disorders.

The Diagnostic Process for MS

To diagnose MS, doctors employ a multifaceted approach:

• Review of medical history
• Neurological examination
• Magnetic Resonance Imaging (MRI) scans
• Spinal tap (lumbar puncture) in some cases

Despite these comprehensive measures, misdiagnosis remains a persistent issue. Dr. Jeffrey Cohen, director of experimental therapeutics at the Mellen MS Center, emphasizes that “Misdiagnosis in MS has been an issue that’s been talked about for 40 years. And even with refinement of diagnostic criteria and the availability of technologies like MRI, it’s still a problem.”

Fibromyalgia: The Elusive Mimicker of MS

Fibromyalgia frequently tops the list of conditions mistaken for MS. Both disorders disproportionately affect women and share several symptoms, including:

• Headaches
• Joint and muscle pain
• Numbness and tingling in extremities
• Memory problems
• Fatigue

How can medical professionals differentiate between fibromyalgia and MS? While MRI scans typically show distinct brain lesions in MS patients, fibromyalgia doesn’t cause these characteristic changes. However, the waters can be muddied when fibromyalgia patients have abnormal MRI results due to unrelated factors.

Neuromyelitis Optica Spectrum Disorder: A Dangerous Misdiagnosis

Neuromyelitis Optica Spectrum Disorder (NMOSD) shares striking similarities with MS, making it a frequent source of misdiagnosis. Both conditions attack the myelin sheaths protecting nerve fibers, but NMOSD primarily targets the optic nerves and spinal cord, often sparing the brain in early stages.

What are the unique symptoms of NMOSD?

• Sudden vision loss or eye pain
• Numbness or loss of sensation in limbs
• Bladder and bowel control difficulties
• Uncontrollable vomiting and hiccups

Why is distinguishing between NMOSD and MS crucial? MS treatments can exacerbate NMOSD, potentially leading to severe consequences. Fortunately, the NMO IgG antibody blood test can help differentiate between these conditions, enabling appropriate treatment strategies.

Small Vessel Ischemic Disease: The Silent MS Impostor

Small vessel ischemic disease, often referred to as cerebral small vessel disease, is a condition that can be easily confused with MS. This “cousin” of stroke results from the hardening of small arteries in the brain, leading to localized injury.

How does small vessel ischemic disease manifest? Patients may experience:

• Abnormal gait
• Urinary incontinence
• Cognitive decline
• Disability

The diagnostic challenge lies in the MRI results. Small vessel ischemic disease can create spots on brain scans that resemble MS lesions, potentially leading to misdiagnosis. Careful interpretation of imaging results, combined with a thorough clinical evaluation, is essential for accurate differentiation.

Sarcoidosis: When Inflammation Mimics MS

Sarcoidosis, an inflammatory autoimmune disease, shares several symptoms with MS, including fatigue and decreased vision. However, it primarily affects the lungs, lymph nodes, and skin.

What are the characteristic symptoms of sarcoidosis?

• Cough or wheezing
• Swollen lymph nodes
• Skin abnormalities (lumps, sores, or discoloration)

While sarcoidosis typically manifests in these areas, it can occasionally cause inflammatory changes in the brain and spinal cord. These neurological manifestations can closely resemble MS, necessitating a comprehensive diagnostic approach to differentiate between the two conditions.

Nutritional Deficiencies: The Overlooked MS Mimickers

Surprisingly, certain nutritional deficiencies can produce symptoms strikingly similar to MS. Two key deficiencies to consider are vitamin B12 and copper.

Vitamin B12 Deficiency

A lack of vitamin B12 can result in a range of neurological symptoms that overlap with MS, including:

• Fatigue
• Mental confusion
• Numbness

How can healthcare providers distinguish between vitamin B12 deficiency and MS? A simple blood test can reveal B12 levels, potentially avoiding unnecessary and invasive diagnostic procedures for MS.

Copper Deficiency

Although less common, copper deficiency can also produce neurological symptoms similar to MS. These may include:

• Weakness
• Numbness
• Difficulty walking

Why is recognizing nutritional deficiencies crucial in MS diagnosis? Identifying and treating these deficiencies can lead to symptom resolution without the need for long-term MS therapies.

Rare Conditions That Can Masquerade as MS

While less common, several rare conditions can present with symptoms similar to MS, further complicating the diagnostic process.

Acute Disseminated Encephalomyelitis (ADEM)

ADEM is a brief but intense attack of inflammation in the brain and spinal cord that damages myelin. It can be triggered by viral infections and occasionally vaccinations.

How does ADEM differ from MS?

• ADEM typically occurs as a single episode
• It often affects children more than adults
• Recovery is usually more complete than in MS

Susac Syndrome

This rare autoimmune disorder affects small blood vessels in the brain, retina, and inner ear. Its symptoms can overlap with MS, including:

• Headaches
• Vision problems
• Hearing loss
• Cognitive difficulties

Why is differentiating Susac syndrome from MS important? The treatment approaches differ significantly, with Susac syndrome often requiring immunosuppressive therapy.

The Role of Advanced Imaging in MS Diagnosis

As diagnostic challenges persist, advanced imaging techniques are playing an increasingly crucial role in distinguishing MS from its mimics.

Magnetic Resonance Imaging (MRI)

MRI remains the gold standard for MS diagnosis, but interpretation requires expertise. How can MRI help differentiate MS from other conditions?

• MS lesions typically have specific patterns and locations
• Contrast enhancement can indicate active inflammation
• Serial MRIs can show disease progression over time

Optical Coherence Tomography (OCT)

OCT is a non-invasive imaging technique that can measure the thickness of the retinal nerve fiber layer. How does OCT contribute to MS diagnosis?

• It can detect optic nerve damage characteristic of MS
• It helps differentiate MS from NMOSD and other conditions
• It can monitor disease progression and treatment efficacy

While these imaging techniques provide valuable information, they must be interpreted in the context of clinical findings and other diagnostic tests.

The Importance of Multidisciplinary Approach in MS Diagnosis

Given the complexity of MS diagnosis, a multidisciplinary approach is often necessary to ensure accuracy. This collaborative effort typically involves:

• Neurologists specializing in MS
• Neuroradiologists
• Ophthalmologists
• Rheumatologists
• Immunologists

How does a multidisciplinary approach improve diagnostic accuracy? By combining diverse expertise, clinicians can consider a wider range of potential diagnoses and interpret complex test results more accurately.

The Role of Patient History and Symptoms

While advanced diagnostic tools are crucial, the importance of a thorough patient history and symptom evaluation cannot be overstated. What key information should clinicians gather?

• Detailed timeline of symptom onset and progression
• Family history of neurological or autoimmune disorders
• Environmental factors and recent infections
• Response to previous treatments or interventions

This comprehensive approach helps paint a fuller clinical picture, guiding further diagnostic steps and reducing the risk of misdiagnosis.

The Future of MS Diagnosis: Emerging Technologies and Biomarkers

As research in MS continues to advance, new diagnostic tools and biomarkers are emerging that may revolutionize the accuracy of MS diagnosis.

Serum Neurofilament Light Chain (sNfL)

sNfL is a protein released into the bloodstream when neurons are damaged. How might sNfL improve MS diagnosis?

• It can indicate ongoing neuronal damage
• Elevated levels may help differentiate MS from its mimics
• It could potentially serve as a marker for disease activity and treatment response

Advanced MRI Techniques

Emerging MRI technologies offer promise in improving diagnostic accuracy. What are some of these advanced techniques?

• Magnetic Resonance Spectroscopy (MRS)
• Diffusion Tensor Imaging (DTI)
• Magnetization Transfer Imaging (MTI)

These techniques provide more detailed information about brain tissue composition and integrity, potentially allowing earlier and more accurate diagnosis of MS.

Artificial Intelligence in MS Diagnosis

Artificial Intelligence (AI) and machine learning algorithms are being developed to assist in MS diagnosis. How might AI contribute to improved diagnostic accuracy?

• Analyzing complex patterns in MRI images
• Integrating diverse data sources for more accurate predictions
• Identifying subtle disease markers that may be overlooked by human observers

While these technologies show promise, they are still in the research phase and require further validation before widespread clinical use.

The Impact of Misdiagnosis: Beyond Medical Consequences

The implications of MS misdiagnosis extend far beyond medical considerations. What are some of the broader impacts of incorrect MS diagnosis?

Psychological and Emotional Effects

Receiving an MS diagnosis, whether correct or not, can have profound psychological consequences. How does misdiagnosis affect patients emotionally?

• Anxiety about an uncertain future
• Depression related to perceived limitations
• Stress from lifestyle changes and treatment regimens
• Identity shifts and changes in self-perception

Social and Relational Impacts

An MS diagnosis can significantly affect a person’s relationships and social life. What challenges might arise from misdiagnosis in this realm?

• Strain on family relationships due to caregiver roles
• Changes in social dynamics and friendships
• Potential impacts on romantic relationships
• Workplace challenges and career implications

Financial Consequences

Misdiagnosis can lead to significant financial burdens. What are some potential financial impacts?

• Costs of unnecessary treatments and medications
• Potential loss of income due to perceived disability
• Expenses related to lifestyle modifications
• Long-term financial planning based on incorrect prognosis

Given these far-reaching consequences, the importance of accurate diagnosis cannot be overstated. It’s crucial for both healthcare providers and patients to remain vigilant and open to reevaluation when symptoms or disease progression don’t align with typical MS patterns.

Patient Advocacy: Empowering Individuals in the Diagnostic Process

In the complex landscape of MS diagnosis, patient advocacy plays a crucial role. How can patients actively participate in ensuring accurate diagnosis?

Self-Education

Knowledge is power when it comes to navigating the healthcare system. What steps can patients take to educate themselves?

• Research reputable sources about MS and its mimics
• Join patient support groups for information sharing
• Attend educational seminars or webinars about MS
• Stay updated on the latest research and diagnostic criteria

Effective Communication with Healthcare Providers

Clear and comprehensive communication with medical professionals is essential. How can patients improve their interactions with healthcare providers?

• Keep a detailed symptom diary
• Prepare questions in advance of appointments
• Be honest and thorough about medical history and lifestyle factors
• Don’t hesitate to seek second opinions when necessary

Navigating the Healthcare System

Understanding how to navigate the healthcare system can lead to more efficient and accurate diagnosis. What strategies can patients employ?

• Research specialists in MS and related disorders
• Understand insurance coverage and referral processes
• Keep organized records of all medical tests and appointments
• Consider working with a patient advocate or case manager

By taking an active role in their healthcare journey, patients can contribute to more accurate diagnoses and better overall outcomes.

16 Conditions That May Be Mistaken for Multiple Sclerosis

Getting a correct diagnosis of multiple sclerosis (MS) can be a challenge. In fact, a study published in May 2019 in the journal Multiple Sclerosis and Related Disorders suggested that nearly 1 in 5 people with other neurologic conditions are mistakenly diagnosed with MS.

These errors in diagnosis likely result from the fact that there is no single test that can determine an MS diagnosis conclusively. Also, not everyone has all of the common symptoms of MS, such as numbness, tingling, pain, fatigue, and heat sensitivity. And to complicate matters, the symptoms you do have may resemble those of some other conditions.

To figure out what’s causing possible MS symptoms, doctors look at your medical history, the results of a neurological exam, and a magnetic resonance imaging (MRI) scan — and sometimes do a spinal tap (also called a lumbar puncture). To accurately diagnose MS, many other possible causes must be considered and excluded.

There are situations when it’s fairly clear that someone does — or doesn’t — have MS, says Devon Conway, MD, a neurologist at the Mellen MS Center in Cleveland. “Then sometimes there are cases where it’s a little more ambiguous; we are considering the possibility of MS but haven’t come to a definitive decision yet. Sometimes it’s necessary to observe the patient and their imaging to try to make a more definitive decision on whether they have MS or not,” says Dr. Conway.

“Misdiagnosis in MS has been an issue that’s been talked about for 40 years,” adds Jeffrey Cohen, MD, director of experimental therapeutics at the Mellen MS Center of the Cleveland Clinic in Ohio. “And even with refinement of diagnostic criteria and the availability of technologies like MRI, it’s still a problem. There are a significant number of people getting misdiagnosed with MS in part because there’s no single test for it, like a blood test.”

Conway agrees, saying, “It’s fairly common to have a misdiagnosis of MS; there’s been a fair amount of research about the need to sometimes ‘undiagnose’ patients. ”

There are several conditions that may be misdiagnosed as MS, some being more likely than others.

Diseases More Likely to Be Misdiagnosed as MS

Similar symptoms may lead to confusion between MS and these diseases, although in most cases, an MRI scan of the brain can rule out MS as the diagnosis — but not always.

1. Fibromyalgia

Fibromyalgia and MS have some similar symptoms, including headaches, joint and muscle pain, numbness and tingling of extremities, memory problems, and fatigue. Like MS, fibromyalgia is more common in women than in men. But, says Conway, fibromyalgia wouldn’t be expected to cause the types of brain or spinal lesions seen on an MRI scan of a person with MS — but sometimes people with fibromyalgia have abnormal MRI results for other reasons.

2. Neuromyelitis Optica Spectrum Disorder (NMOSD)

NMOSD is an inflammatory disease that, like multiple sclerosis, attacks the myelin sheaths — the protective covering of the nerve fibers — of the optic nerves and spinal cord, says Conway. But unlike MS, it usually spares the brain in its early stages.

Symptoms of NMOSD can be similar to MS but can also include sudden vision loss or pain in one or both eyes, numbness or loss of sensation in the arms and legs, difficulty controlling the bladder and bowels, and uncontrollable vomiting and hiccups, according to Oregon Health and Sciences University.

Treatments for MS are ineffective for and can even worsen NMOSD, so getting an accurate diagnosis is extremely important. A blood test known as the NMO IgG antibody test can help to differentiate between MS and NMOSD.

3. 

Small Vessel Ischemic Disease

Small vessel ischemic disease is a “cousin” of stroke, says Conway. “It’s basically injury that occurs to areas of the brain because of hardenings of the small arteries,” he says.

Also called cerebral small vessel disease, this condition can cause disability, abnormal gait, urinary incontinence, and cognitive decline. “On an MRI, the changes that small vessel ischemic disease causes can look like spots that could be mistaken for MS spots,” says Conway.

4. Sarcoidosis

Sarcoidosis is another inflammatory autoimmune disease that shares some symptoms with MS, including fatigue and decreased vision. But sarcoidosis most commonly affects the lungs, lymph nodes, and skin, causing a cough or wheezing, swollen lymph nodes, and lumps, sores, or areas of discoloration on the skin.

“Although this condition primarily affects the lungs, it can sometimes cause inflammatory changes in the brain and spinal cord which can be mistaken for MS,” says Conway.

5. Vitamin B12 deficiency or Copper Deficiency

A vitamin B12 deficiency can cause MS-like symptoms, says Conway. These symptoms can include fatigue, mental confusion, and numbness and tingling in the hands and feet. That’s because vitamin B12 plays a role in the metabolism of fatty acids needed to maintain the myelin sheath. Vitamin B12 deficiency can be identified with a simple blood test.

A deficiency of the mineral copper can also cause symptoms similar to those of a vitamin B12 deficiency.

Diseases Somewhat Likely to Be Misdiagnosed as MS

While overlapping symptoms may lead doctors to think the following diseases might be MS, they are generally less likely to be misdiagnosed as MS than those listed above.

6. Migraine

Migraine is a neurological disease that can cause intense, throbbing headaches; sensitivity to light, sounds, or smells; nausea and vomiting; blurred vision; and light-headedness and fainting.

In the study published in Multiple Sclerosis and Related Disorders in May 2019, researchers from Cedars-Sinai Medical Center and the University of California in Los Angeles (UCLA) found that migraine was the most common correct diagnosis in study subjects who had been misdiagnosed with MS, occurring in 16 percent of the group.

That said, headaches — and headaches caused by migraine in particular — can be the first manifestation of MS, according to a study published in December 2017 in Brain and Behavior.

Migraine can also be difficult to diagnose, and doctors use some of the same tools to diagnose migraine as they do for MS, including taking a medical history and performing a thorough neurological examination.

An MRI can help distinguish between the two diseases, but not always, says Conway. “Both MS and migraine patients can have white matter changes on their MRI, although we can usually, but not always, distinguish between these,” he says.

RELATED: MS and Migraine: What’s the Connection?

7. Spondylopathies

Spondylopathies are a collection of disorders of the vertebrae that usually involve inflammation, such as ankylosing spondylitis. “These conditions are basically degenerative changes in the back and sometimes exert pressure on the spinal cord,” says Conway.

Although spondylopathies may cause symptoms such as joint pain and fatigue that are similar to MS, the MRI images are usually not really consistent with MS, so that’s how we often make the distinction, he says.

In the Cedars-Sinai-UCLA research reported in May 2019, as many as 7 percent of MS misdiagnoses were really spondylopathies

8. 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.

Although this misdiagnosis can be made, generally these disorders don’t have MRI changes associated with them, so that would argue against MS, says Conway. “Some of these patients might have incidental MRI changes that are not really consistent with MS, but they have the spots and they have the symptoms, and so they can get misdiagnosed.”

9. Vasculitis

Vasculitis is an inflammation of the blood vessels that, depending on the type of vasculitis, can cause symptoms often seen in MS, such as fatigue; headache; numbness, tingling, and weakness in the hands and feet; and double vision.

However, other symptoms of vasculitis, such as fever, stomach pain after eating, swelling or hardening of the palms of the hands and soles of the feet, and bleeding under the skin, would not be characteristic of MS.

Vasculitis affecting the skin or bodily organs, like the kidneys, can be diagnosed by examining samples of tissue collected from that area. Some types of vasculitis can also be diagnosed via X-rays or blood tests.

Vasculitis is a rare condition, which makes misdiagnosing it as MS less likely, says Conway. “The changes on the MRIs of people with vasculitis are different from the changes we would see in MS. We can usually distinguish between the two,” he says.

10. Acute Disseminated Encephalomyelitis (ADEM)

ADEM is a severe inflammatory attack affecting the brain and spinal cord. Symptoms include fever, fatigue, headache, nausea, vomiting, vision loss, and difficulty walking. A very rare condition, ADEM typically comes on rapidly, often after a viral or bacterial infection.

ADEM can appear very similar to MS, but ADEM is most commonly a disease of childhood and usually fairly easily distinguishable for MS at presentation, says Conway.

Diseases Less Likely to Be Misdiagnosed as MS

While these diseases may have some symptoms that are similar to those of MS, they also have enough characteristics that are different from MS that misdiagnosing one for the other should happen only rarely.

11. Lyme Disease

Lyme disease is a bacterial infection transmitted through a tick bite. Early symptoms include fatigue, fever, headaches, and muscle and joint aches. Later symptoms can include numbness and tingling in the hands and feet, as well as cognitive problems, such as short-term memory loss and speech issues. If you live in an area that’s known to have Lyme disease or have recently traveled to one, your doctor will want to rule out the possibility.

12. Neuropathy

In the Cedars-Sinai-UCLA study, neuropathy, or nerve damage, was the correct diagnosis for 7 percent of those misdiagnosed with MS.

Both MS and neuropathy involve nerve damage, but whereas MS impacts the central nervous system (CNS), neuropathy usually refers to peripheral neuropathy, or damage to the nervous system outside the brain and spinal cord (which make up the CNS). Peripheral nerves connect the brain and spinal cord to the rest of the body.

Peripheral neuropathy is particularly common in people with diabetes, because high blood glucose levels damage the peripheral nerves.

People with neuropathy may experience loss of coordination, muscle weakness, or difficulty walking or moving their arms or legs, similar to people with MS. However, there are several kinds of neuropathy — sensory, motor, and autonomic — each with their own set of symptoms, and it’s usually fairly easy for a neurologist to distinguish between those two, says Conway. “Although they can produce similar symptoms, the clinical picture is usually a lot different.”

13. Lupus

Lupus is a chronic autoimmune disorder that, like MS, affects more women than men. It can cause muscle pain, joint swelling, fatigue, and headaches. The hallmark symptom of lupus is a butterfly-shaped rash covering the cheeks and bridge of the nose, but only about half of people with lupus develop this rash. There is no single diagnostic test for lupus, and because its symptoms are similar to those of many other conditions, it is sometimes called “the great imitator.”

Rheumatologists (physicians specializing in diseases of the muscles and joints) typically diagnose lupus based on a number of laboratory tests and the number of symptoms characteristic of lupus that a person has.

“Although lupus can affect the nervous system, it’s rare. The changes that we would see in an MRI are usually a little different than what we would see with MS,” says Conway.

14. Stroke

A stroke occurs when a portion of the brain stops receiving a steady supply of blood, and consequently doesn’t get the oxygen and nutrients it needs to survive. Symptoms of a stroke generally evolve rapidly and include loss of vision; loss of feeling in the limbs, usually on one side of the body; difficulty walking; and difficulty speaking. All of these signs can also occur as part of an MS flare, or exacerbation, but there’s a crucial difference.

“The presentation of stroke tends to be very different, because it’s very acute in its onset, and MS is usually a slower process,” says Conway.

The age of the person experiencing the symptoms can also help to pin down the correct diagnosis. While MS can occur at any age, the likelihood of having a stroke goes up with age, while the likelihood of developing MS goes down.

A stroke requires immediate attention; if you think you’re experiencing a stroke, call 911.

15. Sjogren’s Syndrome

In the autoimmune disorder Sjogren’s syndrome, the glands that produce tears and saliva are mistakenly attacked by the immune system, which in turn causes the hallmark symptoms of dry eyes and mouth.

The condition does have shared symptoms with MS, including fatigue and musculoskeletal pain, and, like MS, it is more commonly found in women than in men, says Cohen.

However, this misdiagnosis is unlikely because Sjogren’s is a fairly rare condition, and it would only be a subset of patients whose Sjogren’s would mimic MS, says Conway.

16. Myasthenia Gravis

Myasthenia gravis is a chronic autoimmune disease that causes muscle weakness that typically comes and goes but tends to progress over time. The weakness is caused by a defect in the transmission of nerve impulses to muscles.

In many people, the first signs of myasthenia gravis are drooping eyelids and double vision. Like MS, it can also cause difficulty with walking, speaking, chewing, and swallowing. If a doctor suspects you have myasthenia gravis, a number of tests can help to confirm or rule out the diagnosis.

How a person responds to certain medicines can also aid in the diagnosis. If an anticholinesterase medicine dramatically improves muscle weakness for a brief period, it confirms a diagnosis of myasthenia gravis.

“Myasthenia gravis a disease of the peripheral nervous system,” says Conway. “It’s fairly rare that this condition would be mistaken for MS,” because “patients who have it would present differently in a physical exam.”

Additional reporting by Beth W. Orenstein and Brian P. Dunleavy.

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Conditions That Can Seem Like MS

Written by Alexandra Benisek

• Epstein-Barr Virus
• Vitamin B12 Deficiency
• Diabetes
• Nerve Damage
• Eye Problems
• Stroke
• Lupus and Other Autoimmune Diseases
• Parkinson’s Disease
• Lyme Disease
• Myasthenia Gravis
• ALS
• Guillain-Barre Syndrome
• ADEM
• More

Multiple sclerosis (MS) is a long-lasting disease that affects the nerves in your brain and spinal cord. It’s often hard to diagnose because symptoms vary so much from person to person. They can be mild or serious. They may come and go, or they may get worse over time.

Also, many other conditions have symptoms similar to those of MS. They include:

• Fatigue
• Weakness
• Numbness
• Vision problems
• Trouble walking

Your doctor will need to rule out these other conditions before diagnosing you with MS.

One condition that can also cause long-lasting fatigue is the Epstein-Barr virus (EBV). It’s a common type of herpes virus usually spread through body fluids, like spit. It’s probably best known for causing mononucleosis, or “mono.” Most people will get Epstein-Barr sometime during their lives.

Along with fatigue, EBV symptoms include:

• Head and body aches
• Fever
• Sore throat
• Swollen spleen or liver
• Inflamed lymph nodes in your neck
• Rash

EBV often infects children, who usually have mild or no symptoms. Teenagers and adults may show more clear signs of EBV. Most symptoms tend to clear up in 2-4 weeks, but the fatigue may last for many weeks or months. Once you have this virus, it stays in your body. It can reactivate, and it may or may not cause symptoms.

If you don’t get enough vitamin B12, you might end up with symptoms that look like those of MS.

Vitamin B12 helps your body make red blood cells, DNA, and nerves, among other things. Your body doesn’t make this vitamin naturally. You get it through animal foods (like meat, poultry, eggs, and dairy), foods with B12 added to them, or supplements.

Most adults need 2.4 micrograms of B12 each day. But some people either don’t take in this much, or their bodies don’t absorb enough. If you have a B12 deficiency, you could:

• Feel tingling or numbness in your hands, legs, or feet
• Get very tired and weak
• Have a hard time walking
• Have trouble thinking
• Get a swollen tongue
• Become anemic

The symptoms can come on quickly or gradually.

When you have diabetes, you have too much sugar in your blood. This can lead to serious health issues. With this condition, you may:

• Be very tired or cranky
• Feel hungrier and thirstier
• Pee more
• Lose weight for no reason
• Have blurred vision, slow-healing wounds, or repeated infections

Diabetes can also damage your nerves, a condition called diabetic neuropathy. This can cause numbness, tingling, or pain in your feet and legs. You might also have issues with your urinary tract, heart, digestive system, or blood vessels.

Like MS, diabetes may also lead to vision problems. They result from damage to blood vessels in your eyes. This condition is called diabetic retinopathy.

Type 1 diabetes usually starts when you’re a child or in your teens. Type 2 diabetes is more common in people over 40.

Other things can also cause neuropathy (nerve damage). It can affect you at any age, but people over 65 are more at risk. Along with diabetes and MS, the causes include:

• Injuries
• Immune system disorders like lupus and rheumatoid arthritis
• Infections
• Certain medications (such as chemotherapy) or toxic substances like lead
• Disorders of your circulation (vascular) system
• Alcoholism
• Kidney or liver conditions

Symptoms of neuropathy vary, depending on where in your body the damaged nerves are. Some of the most common symptoms are:

• Tingling
• Numbness
• Muscle weakness
• Pain
• Loss of balance
• Muscle twitches
• Not being able to move a part of your body
• Sweating too much or too little
• Weight loss
• Sexual problems
• Bladder or bowel problems

Many eye issues can cause blurred vision or vision loss, which are also symptoms of MS. Some of the most common ones are:

• Refractive issues (near- and farsightedness)
• Age-related macular degeneration
• Diabetic eye damage
• Amblyopia, or “lazy eye”
• Cataracts
• Glaucoma

Your symptoms will depend on what eye condition you have. But they might include having a hard time reading or driving, trouble seeing at night, or cloudy-looking eyes.

You have a stroke when one of the blood vessels that carries nutrients and oxygen to your brain gets blocked or ruptures. This kills some of your brain cells. In serious cases, strokes can leave you disabled or lead to death.

Symptoms of stroke include:

• Weakness or numbness (especially on just one side of your body)
• Trouble walking
• Confusion
• Problems with speaking or understanding
• Vision trouble
• Dizziness
• An intense headache for no reason

Stroke symptoms happen very suddenly. Get medical help at once if you have them.

Anyone can have a stroke. But they’re more likely in people over 55 and those with other health problems like high blood pressure, diabetes, and heart disease.

Several autoimmune diseases have symptoms that mimic those of MS. An autoimmune disease is one in which your immune system attacks your body’s tissues and organs.

One of the more common autoimmune conditions is lupus. It causes inflammation that affects your skin, joints, brain, kidneys, heart, blood cells, and lungs. In some cases, you get a rash across both cheeks.

Symptoms of lupus include:

• Extreme fatigue
• Fever
• Joint inflammation or pain
• Fingers or toes that turn white or blue at low temperatures
• Chest pain
• Dry eyes
• Shortness of breath
• Headaches
• Memory loss and confusion

Women are more likely to get lupus. It’s usually diagnosed when you’re 15-45 years old.

This nervous system disorder affects your movement. Symptoms start gradually and get worse over time. They differ from person to person but may include:

• Trouble walking
• Trembling
• Slowed movement
• Muscle stiffness
• Problems with posture and balance
• Changes in speech and writing

Symptoms usually begin on one side of your body and affect that side more intensely, even when you have symptoms on both sides.

Most people who get Parkinson’s are 60 or older. It’s more common in men.

You get this disease through a bite from a deer tick, so it usually happens after you’ve spent time in or near the woods. If not treated, Lyme disease can affect your heart, joints, and nervous system.

Common symptoms include:

• Fatigue
• Numbness or tingling in your arms, legs, hands, or feet
• Headache
• Fever
• Skin rash in the area of the tick bite

This immune system disorder causes a breakdown in communication between your muscles and nerves. That leads to muscle weakness and fatigue.

It affects only the muscles you control voluntarily. It most commonly causes problems in your:

• Eyes
• Arms and legs
• Face and throat
• Neck

The muscle weakness tends to get better after you rest. So symptoms can come and go. But they usually get worse over time.

You can get myasthenia gravis at any age, but it’s more common in women under 40 and men over 60.

Amyotrophic lateral sclerosis (ALS or Lou Gehrig’s Disease) affects your brain and spinal cord. Eventually, it causes you to lose control of your muscles.

You may first notice twitching muscles, weakness in your arms or legs, or slurred speech. Other symptoms include:

• Trouble walking
• Weakness in your legs, feet, or hands
• Muscle cramps
• A hard time swallowing
• Changes in your behavior
• Random laughing, crying, or yawning

There’s no cure for ALS. Over time, it makes you less able to speak, eat, move, and breathe.

ALS may run in families. It’s most often diagnosed in people ages 40-65.

This immune system disorder attacks your nerves. It may start with tingling or weakness in your arms and legs and spread to your upper body.

You may also have:

• Trouble walking or climbing stairs
• Double vision
• Loss of facial expression
• A hard time eating
• Body aches and cramps
• Bladder and bowel issues
• Fast heart rate
• High or low blood pressure
• Breathing problems

Eventually, it can paralyze your whole body. If you have it, you’ll likely need to spend time in the hospital. There’s no cure, but most people recover. The majority are able to walk after 6 months.

Doctors don’t know what causes Guillain-Barre syndrome. But many people who get it had an infection (such as a respiratory or digestive system infection) a few weeks before.

Acute disseminated encephalomyelitis (ADEM) is a rare brain and nervous system disorder that can follow a viral or bacterial infection (like an upper respiratory infection). Doctors believe it’s an immune reaction to the infection.

Anyone can get it, but it most often affects children. It commonly causes headaches and fever.

Other symptoms may include:

• Weakness in your arms and legs
• Tingling and numbness
• Vision problems
• Loss of balance
• Confusion
• Trouble swallowing

These symptoms tend to come on suddenly. With treatment, most people start to get better in days and are fully recovered within a few months.

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What can be confused with multiple sclerosis?

03/21/2023

The title of the article was suggested to us by a community member in our VKontakte group. We decided to answer this question in detail, a little scientifically, but trying to use understandable language.

Multiple sclerosis is a difficult disease to diagnose. In this article, we will analyze the basic principles of the so-called differential diagnosis – a step-by-step examination to rule out diseases similar to MS.

Other demyelinating diseases

Previously, all demyelinating diseases were multiple sclerosis. However, over time, with the development of diagnostics, other demyelinating diseases of the central nervous system began to be isolated. Currently, in addition to multiple sclerosis, they include: Devic’s neuromyelitis optica, neuromyelitis optica spectrum disease, acute disseminated encephalomyelitis, and recurrent optic neuritis. These diseases are very similar to multiple sclerosis both in their manifestations (impaired functions in humans) and changes in MRI. To make a final diagnosis, additional examinations are required, and sometimes we take a break for diagnostics and observe the patient for some time.

Systemic diseases

This is a group of autoimmune diseases, which, like in multiple sclerosis, are based on a malfunction in the immune system. But unlike multiple sclerosis, when changes are localized exclusively in the brain and spinal cord, immunity in systemic diseases begins to damage various organs: joints, heart, kidneys, including the brain. One of the important links in the development of a systemic disease is vasculitis – an autoimmune inflammation of small vessels. There are small vessels in all organs, including the brain, so small scattered areas of damage can occur in the areas of blood supply to small vessels.

There are many systemic diseases: antiphospholipid syndrome, systemic lupus erythematosus, systemic vasculitis, Sjögren’s syndrome, Behcet’s disease, sarcoidosis, etc. On MRI, lesions in such diseases usually differ from lesions in multiple sclerosis, but at the beginning of the disease, when the changes are mild, implicit, a fairly wide additional examination in the form of blood tests is required, since MRI does not give an unambiguous answer to the nature of the focus ov. And one more thing: a person can have two diseases at the same time – both systemic and multiple sclerosis. In this case, deep knowledge and experience of the doctor is required to make the correct diagnosis and select therapy.

Hereditary diseases

Among the genetic diseases, there are those similar to multiple sclerosis with onset at a young age, with various dysfunctions and foci on MRI. These include mitochondrial encephalopathy, adrenoleukodystrophy, Leber’s disease, CADASIL syndrome, etc. But still, each of these diseases has unique features that clearly indicate a genetic disease. Sometimes we have to do a genetic test to rule out such diseases.

Infections

Bacteria and viruses can selectively damage the brain and spinal cord, causing infectious encephalitis and myelitis. But an infection is an infection, and such lesions occur with fever and symptoms that clearly indicate an infectious lesion of the central nervous system.

It is much more difficult to distinguish multiple sclerosis from Lyme disease – neuroborreliosis. Borrelia are also bacteria that enter the human body with a tick bite. The peculiarity of borrelia is that they not only directly affect the brain, which forms foci similar to foci in MS, but also that the immune system, fighting with borrelia, begins to produce antibodies to them. But these antibodies can be so special in structure that they can recognize not only Borrelia, but also components of the nervous system and cause an immune response already on these tissues, in particular on the white matter of the brain or spinal cord. Those. in this case, the action of Borrelia will be mediated through a malfunction in the immune system. And in this case, we need to conduct additional examinations, including blood and cerebrospinal fluid tests to distinguish between neuroborreliosis and multiple sclerosis.

The AIDS syndrome may present with what is known as progressive multifocal leukodystrophy (PML). PML develops in people with a long history of HIV infection, when, due to lack of treatment or the nature of the course of the infection, such a decrease in immunity occurs that an infection with another virus, called Jc, develops. This virus begins to rapidly damage the white matter of the brain, often leading to death.

Migraine

The main manifestation of migraine is paroxysmal, often unilateral, throbbing headache. However, pain is often preceded by a complex of manifestations, symptoms, indicated by an aura. Sometimes the aura may be accompanied by decreased vision in one eye, weakness of the limbs, numbness of the arm or leg, dizziness, impaired sense of smell.

As can be seen, both reduced vision in one eye and weakness/numbness of the extremities can be manifestations of multiple sclerosis. The main distinguishing feature is the duration of the symptoms: with a migraine, they last from several minutes to half an hour and must completely disappear, giving way to a headache.

Migraine MRI may show lesions in the brain, but they are completely different from the demyelination lesions seen on imaging in people with MS.

Stroke

Sudden occlusion of a vessel that supplies blood to a part of the brain leads to acutely developing symptoms: unilateral weakness of the limbs, impaired speech, unilateral loss of visual field, and distortion of the face.

However, a stroke is quite easy to distinguish from an exacerbation of multiple sclerosis: in MS, symptoms rarely occur acutely, not within seconds or minutes, as in a stroke, but over hours or days. On MRI of the brain in stroke, a site of cerebral infarction is visible: zones of irreversible damage to nerve cells, while in MS we see scattered foci of inflammatory changes. These changes are quite easy to distinguish from each other.

Tumors

Primary tumors can occur in the brain: astrocytomas, glioblastomas, meningiomas, etc. If manifestations, disturbances in the functioning of the nervous system sometimes resemble exacerbations in multiple sclerosis, then MRI can quite definitely indicate a tumor, confuse it RS is difficult.

Brain metastases are another matter: there are usually many small foci that accumulate contrast, which may resemble an exacerbation of multiple sclerosis. However, the presence of a primary tumor in the body and certain characteristics on MRI make it possible to reliably distinguish metastases from MS foci.

Finally, lymphoma: this tumor often resembles multiple sclerosis and affects the lymphatic system of the brain and spinal cord. It often takes a lot of effort to rule out lymphoma.

Thus, a specialist in multiple sclerosis needs knowledge, a correct interpretation of the picture of the disease, so as not to prescribe excessive tests, but to perform the necessary range of examinations to exclude similar diseases and make the correct diagnosis: do not get confused in the symptoms and not “confuse multiple sclerosis with something else. ” Ultimately, the correct diagnosis makes it possible not to delay the treatment of multiple sclerosis and to choose the most effective drug.

The Moscow Multiple Sclerosis Center performs a complete diagnosis of multiple sclerosis, excluding other diseases, as our doctors have the necessary knowledge and experience.

Metabolic syndrome: symptoms, diagnosis, risk factors

Views:
13157

Published:
07/22/2019

/

Updated:

04/09/2022

• Obesity
• Diabetes

General

Modern medicine considers the metabolic syndrome as a set of associated factors that, together and individually, increase the risk of cardiovascular disease, stroke, and type 2 diabetes.

Pathological factors include high blood pressure, high blood sugar, accumulation of visceral fat, and abnormal blood cholesterol or triglyceride levels.

The presence of only one of these factors does not indicate a metabolic syndrome, but indicates a certain risk of its development and complications in the future. The more predisposing factors, the higher the risk of complications.

Mechanism of development of the metabolic syndrome

Most researchers believe that the primary etiopathogenetic mechanism for the development of the metabolic syndrome is primary insulin resistance. It is she who launches a chain of metabolic and hormonal disorders, contributes to the development of abdominal obesity.

Insulin resistance impairs the utilization of glucose by cells in peripheral tissues and the cells respond abnormally to insulin. Insulin is a hormone produced by the beta cells of the pancreas. The hormone helps sugar get inside the cell and be used as fuel.

In insulin insensitivity, glucose cannot easily enter the cells, resulting in increased workload on pancreatic beta cells and increased insulin production (hyperinsulinemia). For a while, this allows you to keep the level of sugar in the normal range, but then the glucose level rises, despite the fact that the body produces more and more insulin. On the one hand, hyperinsulinemia is a compensatory reaction, on the other hand, it is a pathological mechanism that contributes to the occurrence of other metabolic, hemodynamic and organ disorders.

The mechanisms by which insulin resistance develops are still being studied. But it is known that the development of insulin resistance is a consequence of genetic and environmental influences. There are several levels of breakdowns leading to the formation of an insulin resistance complex.

1. First level – described genetic mutations that cause initially abnormal insulin to form.

2. The second level is the pathology of the insulin receptors themselves, which is manifested by insulin insensitivity, a reduced number or destruction of receptors under the action of antibodies synthesized by the immune system.

3. The third level is a violation of the signal transmission process, when insulin and receptors are working, but there is a violation of the signal inside the cell.

In many ways, certain behavioral responses contribute to the development of insulin resistance and metabolic syndrome:

• Tendency to overeat or imbalance in nutrition. Associated with an increase in the proportion of carbohydrates and fats in the diet, the use of fast carbohydrates, trans fats, a tendency to frequent snacks and food on the go.
• Sedentary lifestyle.
• Lack of skills to counteract emotional and other stresses.
• Smoking, alcohol abuse.
• Disturbance of normal nasal breathing (apnea), especially during sleep.
• Long-term untreated or poorly treated arterial hypertension.

Metabolic syndrome is closely associated with being overweight or obese and inactive.

Risk Factors for Metabolic Syndrome

Metabolic syndrome is closely associated with overweight or obesity, lack of physical activity. Therefore, people with abdominal obesity, insulin resistance and inactive lifestyles have the highest risk of developing metabolic syndrome.

The following factors increase the chances of developing metabolic syndrome:

1. Age. The risk of metabolic syndrome increases with age.

2. Race and ethnicity. Hispanics are at the highest risk of developing metabolic syndrome.

3. Diabetes mellitus. A person with a personal (eg, gestational diabetes) and family history of type 2 diabetes is at risk of developing metabolic syndrome. It has been proven that the metabolic syndrome in 80% of cases is associated with type 2 diabetes mellitus.

4. Other diseases. The risk of metabolic syndrome is higher with associated conditions: non-alcoholic fatty liver disease, gallstone disease, atherogenic dyslipidemia, polycystic ovary syndrome, and gonadal dysfunction in men.

In some cases, the metabolic syndrome is associated with endothelial dysfunction, renal dysfunction (micro- and macroalbuminuria), inflammation (increased C-reactive protein (CRP), interleukins and other inflammatory mediators), hypercoagulability (increased fibrinogen and tissue plasminogen activator-1 inhibitor), atherosclerosis.

Symptoms

Metabolic syndrome develops gradually and is not accompanied by any clinical symptoms for a long time. Most of the disorders associated with the metabolic syndrome have no obvious manifestations and can be detected incidentally through laboratory examination. The only noticeable sign indicating metabolic syndrome is a large waist circumference and a characteristic distribution of adipose tissue. With metabolic syndrome, fat deposition occurs in the abdomen and upper shoulder girdle.

Diagnostic criteria

Main criterion:

• Central (abdominal) type of obesity – waist circumference over 80 cm in women and over 94 cm in men.

Additional criteria:

• BP >130 and 85 mmHg, or treatment of hypertension with drugs.

Lipidogram :

• Elevated triglycerides ≥ 1.7 mmol/l.
• Increased LDL cholesterol > 3. 0 mmol/L.
• Reducing HDL-C < 1.0 mmol/l in men and HDL-C < 1.2 in women.

Early disorders of carbohydrate metabolism:

• Impaired fasting glycemia (IFG) – elevated fasting plasma glucose ≥ 6.1 and < 7.0 mmol/L. Plasma glucose level 2 hours after loading 75 g glucose < 7.8 mmol/l.
• Impaired glucose tolerance (IGT) is an elevated plasma glucose level 2 hours after a 75 g glucose load ≥ 7.8 and < 11.1 mmol/L. Fasting plasma glucose is less than 7.0 mmol/L.
• Combined UHN/IGT disorder – Elevated fasting plasma glucose ≥ 6.1 and < 7.0 mmol/L in combination with an increase in plasma glucose 2 hours after 75 g glucose load ≥ 7.8 and < 11.1 mmol/L.

The basis for the diagnosis of metabolic syndrome is a combination of obesity and any two additional criteria.

Prevention

A lifelong commitment to a healthy lifestyle helps prevent the development of metabolic syndrome.

A healthy lifestyle includes:

• Getting at least 30 minutes of physical activity daily.