Multiple Sclerosis Differential Diagnoses And Workups

CSF exam

Upon examining the cerebrospinal fluid of those who have been diagnosed with multiple sclerosis, otherwise referred to as MS, electrophoretic patterns can be observed. These patterns are made up of oligoclonal bands that indicate any significant increase in the person’s IgG. In fact, roughly eighty-five percent of MS patients demonstrate this finding.

Usually, the glucose level is within normal range. However, the protein level can be either normal or mildly increased. And the white blood cells range from slightly up to moderately increased but no exceeding five, specifically the mononuclear cells.

The MBP or the myelin basic protein is an important workup in MS. This component of myelin is increased in multiple sclerosis. Still, however, physicians do not recommend using the MBP’s as the marker to indicate the disease process or the progression of multiple sclerosis.

Blood tests

Those with MS must be tested for their B12 and their Folate levels, including their antinuclear antibody, or their ANA titers. Such tests are essential whenever there is evidence of a fast-acting deterioration in the cognition or degeneration of the person’s spinal cord.

Multiple sclerotic people experiencing optic neuritis and spinal cord lesions that are somewhat extensive should go to the laboratory to be tested for NMO or neuromyelitis optica. This test will determine the presence of antibodies of aquaporin 4 flowing within the serum.

An ESR or an erythrocyte sedimentation rate must also be taken, along with positive titers of a rheumatoid factor. These specific blood tests help in identifying if the disease being experienced by the person is indeed MS or just a vasculitic disease that apes multiple sclerosis.

Imaging studies

An MRI scan of either the head or the spine, with or without gadolinium, must be performed depending on whichever location the lesions are suspected.

Lesions that appear in relation to the onset of multiple sclerosis typically appear looking like T2 hyperintensities located within periventricular areas. These typical lesions have an ovoid shape and usually affect the white matter only. In some cases, several lesions grow from the corpus callosum of the brain.

Whenever the scans indicate lesions from the corpus callosum, this is termed as Dawson fingers. This term came from the work done by James Dawson back in 1916 as a neuropathologic test at the University of Edinburgh. This kind of condition indicates that the cells associated with inflammation have been distributed perivascularly into the veins and the venules of the brain tissues.

Imaging studies can also show any formations of plaque, especially in infratentorial regions. Moreover, the most common infratentorial areas affected by the plaques are the cerebellar peduncles, the pons’ surface and also the white matter part closest to the fourth ventricle.

Once gadolinium is used as the contrast dye, some lesions become luminescent. This result is indicative of an active disease process. Such luminescence means the BBB or the blood-brain barrier has broken down because of a constant subacute process of inflammation, ranging from a few days up to several weeks.

If a combination of both luminescent and non-luminescent lesions is observed, then this would further indicate the chronicity of the disease’s demyelinating process.