Differentiating diagnosis of WMLs Flashcards
MS Differential Diagnosis
No single clinical feature or test is sufficient
What are the diagnostic criteria for MS?
- Dissemination in space
- Dissemination in time
- Reasonable exclusion of alternative
What is dissemination in space?
Two or more parts of CNS= in brain not always the same area
What is dissemination in time?
Damage that occurs on different dates
Symptoms should not happen at the same time
Why is misdiagnosis of MS an issue?
- Often common conditions with non-specific symptoms, signs, MRI findings
- NMOSD
What does NMOSD stand for?
Neuromyelitis optica spectrum disorder
What is NMOSD?
Inflammatory disorder of CNS characterised by severe, immune-mediated demyelination and axonal damage targeting optic nerves and spinal cord
What are the clinical diagnosis of MS?
- Age
- Signs
- Symptoms
- CSF
What are the MR diagnosis of MS?
- Pattern
- Shape
- Enhancement
- SWI
- Other
What are examples of pattern?
- PV
- Cortical
- Sub-cortical
- ON
- CC
- Spinal cord
What are the shape of MS?
- Oval
2. Dawson’s finger
MR MS pattern: location
Immediately adjacent to PV, within cortex (cortical), below subcortical, Optic nerve, CC, Spinal cord
MR MS pattern: shape
- Oval
2. Dawson’s finger
MR MS pattern: Enhancement
4-6 weeks, sometimes 3 months, usually 4 weeks
MR MS pattern: SWI
CVS
Iron deposition
Where do lesions develop?
Around the vein with the vein at the centre
What are immediately adjacent to cortex?
U fibres
What are the function of U fibres?
Connect one gyrus to another
When do enhancing and non-enhancing lesions happen?
Enhancing: 3-4 weeks
Non-enhancing: much older
In posterior fossa, where are lesions?
Along intermedullary course
What are silent lesions?
Patients can have lesions not manifesting themselves clinically