Objective
To present a case series of patients previously diagnosed as multiple sclerosis (MS) which were later confirmed as an alternative diagnosis, and describe the clinical and paraclinical signs that led to this change.
Method
Nine patients are described. We reviewed the patient’s clinical chart, magnetic resonance images (MRI) and cerebrospinal fluid.
Results
There was a mean of three typical symptoms of MS and four clinical red flags per patient. MRI red flags were found in 88,9% of all referrals, with a mean of 3 encountered per patient.
Conclusion
We identified that, not only the misdiagnosed patients did not fulfill MS diagnosis criteria, but also how the described red flags are a useful tool in the differentiation of MS from other diseases. This data is important for guiding future diagnosis, especially for general clinicians and neurologists, which directly interfere with the patient’s management, treatment, prognosis and quality of life.
multiple sclerosis; diagnosis; clinical; MRI red flags
Numbers correspond to same patient on Table 1; images with letters are from the same patients at different time points. All are FLAIR images except image 7 DWI, which is a diffusion weighted image. Note that only patient 6 presents typical periventricular (including temporal horn) and justacortical multiple sclerosis lesions, all other images present at least one red flag as presented on Table 2.
A: Sagittal T2 image disclosing central lesion without edema; B: axial T2 image disclosing this same lesion to be an enlargement of the central spinal canal (this lesion does not enhance); C: axial T2 image disclosing typical multiple sclerosis lesion in the lateral funiculum; D: axial T1 post gadolinium disclosing enhancement of the lesion shown in C.
Numbers correspond to the same patients on Table 1 and exact same imaging time point as on Figure 1. Note that these images present a contrast enhancement pattern not typical for MS, thus representing red flags as discussed on Table 2.