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Differential diagnosis of suspected MS
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Differential diagnosis of suspected MS

Hi there,

We talk so much about how difficult it is to dx this disease, I thought you would all enjoy this read. It's an article published in 08, however, I found it to still be a solid source of information.  I've read it more than a handful of times to let it all sink in throught the years.

Included in the write up are both exclusionary and supportive finds to support or distinguish betweeen differental dx of MS, and a useful table with 79 clinical and paraclinical red flag findings of patents who present with CNS disease when MS is being considered.

There are also 36 major red flags that point to non-MS dx, 11 minor red flags that suggest possible dx and 32 clinical paraclinical and lab and imaging findings/examples.

While we always say we cannot dx MS on this forum, we can only collectively pull our experience and expertise together to help each other through the journey, learn, support, provide facts best we can, etc. - I hope you find this small piece of info useful as I did in, in at least understanding why the journey of dx can be so long and muddy (excluding all the "other" reasons it can be long, hahah - i.e., when we are not in good care).

Check it out:
http://msj.sagepub.com/content/14/9/1157.full.pdf+html

-Shell
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You are an angel.  I used to be resourceful as well but after my visit tor 2nd opinion visit with my new  neurologist, I have sort of just gave up hope.  I've  tried  to help my family  understand how horrible I feel with these symptoms which very much mimic ms. With this resource it will help me have peace of mind.
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1225331_tn?1333369369
Shell, thanks for sharing. This is great!
-Kelly  :-)
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You are an angel.  I used to be resourceful as well but after my visit tor 2nd opinion visit with my new  neurologist, I have sort of just gave up hope.  I've  tried  to help my family  understand how horrible I feel with these symptoms which very much mimic ms. With this resource it will help me have peace of mind.
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198419_tn?1360245956
Kell - you are very welcome! Glad you liked it.

Supergirl - I'm not as resourceful as I use to be either. HOpe your family learns how you are feeling, it's horrible when people don't see and just be there for us because they noticed :(

Hope more take the opportunity to peek at this too.
-shell
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1466984_tn?1310564208
Thanks for posting this Shell.   I had seen it before - a while back, but forgot about it.  In looking at it again - it makes a bit more sense to me since I have learned more in going through this process -  It's also reassuring that we are not crazy - this whole area is pretty complicated and even the best of the best can have great difficulty in figuring it all out.

BUT - if I really want to understand it, I will have some research to do.  I don't know what a lot of the "big" words mean.  But I love a challenge - AND it's a great resource to have.
Thanks again.
Carol
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1312898_tn?1314571733
Thank you so much for the link to the paper.  I have studied it and have it bookmarked.  It is mind boggling at the sheer number of differentials there are with MS.  Just reading this helps me understand why doctors aren't in a rush to give a M.S. diagnosis, even when it seems obvious.  So, it gives me a dose of respect to physicians, even though they sometimes are jerks.

Red
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1394601_tn?1328035908
Thank you, Shell.  Very informative!  I have bookmarked it as well.
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The neuro I was seeing should see this.... but then he'd have to learn how to read the MRI, I had the number one red flag- bone lesions, and several others such as Livedo.  I was finally diagnosed correctly by a resident who was willing to listen to me and ovserve.
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572651_tn?1333939396
If you want to see a bit more on differential diagnosis, checkout the website

diagnosispro.com -

this is an online site intended for medical folks to use when determining differential dx.  Pretty interesting stuff to see what doctors must think about.  

Thanks, Shell, for bringing this up- this is an important discussion to hold.
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572651_tn?1333939396
*bump* for the discussion on why dx'ing MS is so hard!
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147426_tn?1317269232
I keep this article on hand for frequent reference.  How the "flags" were chosen was an interesting process and they had experts rank them and only listed the major and minor ones because pretty much everyone agreed.  The moderate had mixed opinions (as we see often on the forum).

Thanks for pointing everyone to it!

Even when EVERYTHING about some points toward MS, some little detail can sometimes show the actual diagnosis to be something else.  We can't fixate on a diagnosis until all the info (the Differential Diagnosis) is investigated.

Quix
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198419_tn?1360245956
Bump for those who have not the chance to read the article.

Please do if you can, especially our undiagnosed.

-shell
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572651_tn?1333939396
As I read this paper repeatedly, it always strikes me as to how angry I would be if I was dx'd with MS when I actually should be treated for something else, such as summerlvrs case and her cancer.

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Avatar_n_tn
you mean not actually being diagnosed with anything and not receiving treatment for several years? :O I've tried twice to figure out how to file a formal complaint but no one from the hospital has got back to me.  THe only thing I've been able to do was add a very poor rating on "rate my MD. com"  to try and warn others. It's funny that the other neuro I saw was condescending as well. Not much nice to say about my experience with neurology. So many things went wrong.  Even my MRI was misread.  Only on the second "read" did they notice the bone lesions in my spine.


from what I've read about my cancer many people are diagnosed with a precursor syndrome of raised protein and they don't actually go on to develop the cancer but are followed closely just in case.  Getting diagnosed with a later stage myeloma is not so common. My cancer doc is a real treasure though. I'm blessed now with great care.
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great resource,

thx
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sllowe & Doc Q,

an anger brain cell just went on, yeah, i know, you knew it would.

some of the things this article mentions especially, CIS and ADEM, is clearly put in their respective places, and thank goodness too. the VA certainly has used those two to delay diagnosis thus delaying legal/rightful disability issues for veterans.

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Thanks for bumping this up, Shell.  Quite interesting.  Same with the site Lulu  gave.  I am saving both sites!

Thanks again,
Addi
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198419_tn?1360245956
Bump for all of our undiagnosed newcomers.

Not all lesions are MS. Please check out this article. Provides much insight on why MS can take so long to diagnose.  http://msj.sagepub.com/content/14/9/1157.full.pdf+html

Remember, not all brain lesions = MS and not all spine lesions = MS. In the end, MS is a clinical dx.
-Shell
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1453990_tn?1329235026
And, it is a diagnosis of exclusion.  Once they exclude the mimics, the they can diagnose MS.  The insurance companies pretty much hold them to this.  Depending on your insurance, it can cost you a chunk of money to exclude all the mimics.

Bob
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572651_tn?1333939396
This is really important to understand, especially for everyone still looking for answers.

Here is the link to the companion health page that was done on this topic.

http://www.medhelp.org/health_pages/Multiple-Sclerosis/What-Neurologists-Must-Consider/show/1219?cid=36
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198419_tn?1360245956
Differential dx - this link(and Lu's companion healthpage) is a useful read for those undiagnosed members.........

http://msj.sagepub.com/content/14/9/1157.full.pdf+html

-shell

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1760800_tn?1406757051
Thanks for this article -  the people in my life have such a hard time understanding that this is a disease of exclusion and that there are so many mimics -  I get the question - well can't "they" just do a test -  unfortunately "they" cannot!  Wouldn't that be nice!  Make all our lives much easier!

Thanks a bunch Shell
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198419_tn?1360245956
Jacks! Your very welcome! And, yes, man would that make life easier for many of us, including the docs.
To confuse the exhaustive and difficult dx even further.......please read this article.....

http://www.medhelp.org/posts/Multiple-Sclerosis/MS-and-References-to-DX-of-Exclusion/show/1602461?personal_page_id=864133

The last thing anyone with MS should feel is that "they have nothing else," "everything" imaginable was ruled out, so they MUST have MS.

It's simply not true - there has to be evidence of MS in the 1st place.

(((Hugs))))
shell
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