differential diagnosis of multiple sclerosis Flashcards
what symptoms are unlikely to be the first presentation in MS ?
seizures
dementia
dysphagia
pain
movement disorder
systemic affection - skin lesions
normal MRI
what are the common inflammatory phenocopies that could be DD of MS ?
transverse myelitis
neuromyelitis optica
ADEMS
Sarcoidosis
SLE
Behcet syndrome
Cerebral Vasculitis
what is transverse myelitis ?
inflammation of the spinal cord
what are the causes of TM ?
MS
para infectious
post vaccination
para neoplastic
systemic autoimmune
what do we give to a patient with TM ?
pulse steroids
what is the nature of the lesion in TM ?
takes more than 3 segments ( unlike MS has a shorter segment )
What is NMO or Devics disease ?
neuromyelitis optica
optic neuritis plus myelitis
plus 2 or 3 of :
brain MRI is normal no MS
longitudinally extensive cord lesion
NMO igG (aquaporine 4 positive )
it is an autoimmune disease
in what race is NMO more commonly seen in?
Japanese people
what is the response of NMO to steroids ?
optic neuritis here is usually very severe and doesn’t respond to steroids
what is the suggestive treatment for NMO ?
pulse steroids and plasmapheresis
what is ADEM ?
acute disseminated encephalomyelitis that is mono-phasic so only presents with 1 attack that affects the brain and the spinal cord
If we have a child presenting with MS like symptoms what is crucial to ask about in history ?
post vaccination
post infection
what are the causes of ADEM ?
post infectious
post vaccination
what is the presentation of ADEM ?
cortical presentation so an affection of grey matter more
so
fever
seizures
headache
subconscious levels
what do we give a patient with ADEM ?
pulse steroids
If we have a child presenting with fever , seizures and headaches what could be the possible diagnosis ?
ADEM
what do the lesions in MRI of ADEM look like ?
huge lesions on MRI
what is sarcoidosis ?
an multisystem inflammatory disease characteristic with a non caseating granuloma
what race is common in sarcoidosis ?
afro-carribeans
what are the presenting symptoms of sarcoidosis ?
cough
dyspnea
systemic rash
weight loss
uveitis
parotitis
lymphadenopathy
what is the presentation of neuro-sarcoidosis ?
meningeal infiltration causing headaches, seizure
cranial nerve affection
which nerve is commonly affected inn neuro-sarcoidosis?
7th cranial nerve
do we find any meningial infiltration in MS ?
no meningeal infiltration
what is the triad of Behcet’s disease ?
oral ulcers ( asasi)
genital ulcers ( painful)
uveitis
skin lesion
in which nationality is behcet more common in ?
turkey > asia > western
males
what test is diagnostic in Behcet’s ?
pathergy test
erythematous papules that lasts for more than 24 hours
what can be seen in neuro-behcets disease ?
psychiatric complications
cerebral venous thrombosis
what is SLE ?
autoimmune multi-system organ affection with a malar rash , discoid rash , serositis , arthritis
what are the labs for SLE ?
ANA dsDNA antibodies
what are the features of neuro-lupus ?
neuro-psychiatric presentation
painless optic neuritis
chorea
what is sjorgren’s syndrome ?
xerostomia
xerophtlamia
rheumatoid arthritis
what is the immunological panel for Sjorgen’s syndrome ?
Anti-ro
anti- la
“autoimmune disease of the brain”
cerebral vasculitis , its non specific
what is the clinical presentation of giant cell arteritis ?
jaw claudication
temporal headache
biopsy of the temporal artery is diagnostic
what is another diagnostic feature of sarcoidosis ?
increased ACE levels
what is the disease course for devics disease ?
poor recovery between attacks
what is the diagnostic test for sjogren syndrome ?
Schirmer’s test
to test if the eye produces enough tears
what does normal aging look like on imaging ?
fazekaz
peri ventricular caps
how can you see CADASIL on brain MRI ?
extension from the ventricles
what symptoms may point towards spondylopathy ?
pain in their back
pain on movement
