Approach in Diagnosis and Management and Common Mistakes in Diagnosis of Multiple Sclerosis

Background- Augustus d'Este, the grandson of England’s King George III, is now thought to have MS based on a diary he kept until his death in 1848, in which he described symptoms that sound much like MS, including blurred vision, weakness and numbness in his limbs, tremors and nocturnal spasms. Twenty years after d’Este’s death, the Parisian neurologist Jean-Martin Charcot was the first to identify and name MS. A female patient of Charcot’s was suffered from tremors, slurred speech and abnormal eye movements. He attempted to treat her, but with no avail. After her death, Charcot examined the patient’s brain and discovered the telltale plaques of MS the hardened scar tissue around nerve fibers. He was concerned with the discovery of MS. Aim of the work: multiple sclerosis is considered as one of the great imitators as it features various nonspecific symptoms such as sensory loss, spinal cord symptoms (Motor and autonomic), cerebellar symptoms, eye symptoms, optic neuritis, trigeminal neuralgia, psychiatric as well as constitutional symptoms and may be confused with a number of other diseases. In this project we aimed to identify problems and mistakes for diagnosis of MS in order to achieve early diagnosis and prevention of misdiagnosis and advancement of the disease. Patients and Methods: we have collected data about cases of multiple sclerosis disease from two major hospitals in Saudi Arabia (Saudi German Hospital, Madinah, Dammam Medical Complex, Dammam) during the year 2017. Among these cases we found 4 cases misdiagnosed as multiple sclerosis. The first case 48 years old female diagnosed with multiple sclerosis and treated with Imuran for 8 month with no benefit then patient came again with the same symptoms and MRI done for him with no change in MRI findings, thus the patient condition was not fit for the diagnostic criteria of multiple sclerosis and diagnosed as primary lateral sclerosis. Second case 37 years old patient came with acute onset paraplegia and diagnosed as transverse myelitis then came after 4 months; the patient developed symptoms of optic neuritis. The third case 42 years old female came with left sided hemiplegia and diagnosed as ischemic stroke and treated with vascular therapy without benefit then came again after 6 months with right sided hemiplegia and incoordination then diagnosed as multiple sclerosis. Fourth case 30 years old female came with acute diminution of vision and diagnosed as optic neuritis and treated without benefit then patient came again with the same presentation and diagnosed as clinically isolated syndrome. Results: MRI findings are not enough in diagnosis of multiple sclerosis and should be accompanied by good clinical expertise; lab tests as well as exclusion of any other condition could be misdiagnosed as multiple sclerosis. Conclusion: multiple sclerosis (MS) is an immune-mediated inflammatory disease that attacks myelinated axons in the central nervous system, destroying the myelin and the axon in variable degrees and producing significant physical disability within 20-25 years in more than 30% of patients. The hallmark of MS is symptomatic episodes that occur months or years apart and affect different anatomic locations.