"A very specific test for MG is a blood test for serum antibodies to acetylcholine receptors," Burks explains. "Eighty percent of all patients with MG will have abnormally elevated serum levels of these antibodies."
Sarcoidosis typically appears between the ages of 20 and 40. Usually, the disease appears briefly and heals naturally. However, between 20 and 30 percent of sarcoidosis patients are left with some permanent lung damage, and in 10 to 15 percent of the patients, the disease can become chronic. Symptoms include dry mouth, excessive thirst and fatigue, skin rash, vision abnormalities, chronic arthritis, shortness of breath, enlarged lymph glands, cough and fever. A chest x-ray is one of the most helpful diagnostic tools.
INFECTIOUS DISEASES THAT MIMIC MS
Lyme disease (LD) is an infection caused by Borrelia burgdorferi, a bacterium carried by deer ticks. Untreated, the bacterium travels through the bloodstream, causing severe fatigue, a stiff, aching neck, tingling or numbness in the extremities, and facial palsy. The primary symptom is usually a rash that radiates from the tick bite. Diagnosis should be made on the basis of symptoms and evidence of a tick bite, not blood tests, which can often give false results if performed in the first month after infection.
Those who live or work in residential areas surrounded by tick-infested woods, or enjoy hiking, camping, fishing and hunting, or live in endemic areas are at increased risk for this disease.
Human T-cell lymphotrophic virus-1 (HTLV-1) is associated with progressive spinal cord dysfunction. Symptoms include spasticity, partial paralysis of the lower limbs, bladder and bowel incontinence, and impotence. HTLV-1 can be ruled out with a titer, which is a type of elevated antibody test. "HTLV-1 affects the spinal cord and does appear similar to primary progressive MS," Burks explains. "But HTLV-1 primarily occurs in the Caribbean, so it is important to ask about travel to endemic areas. Besides the Caribbean, these areas include Southern Japan and less commonly, the Pacific Coast of South America, Equatorial Africa and the Southern United States. HTLV-1 is also common among intravenous drug users."
Neurosyphilis, the advanced form of syphilis, can cause visual problems, cognitive changes, and sensory or motor tract dysfunction. As with HTLV-1, testing the production of antibodies can eliminate syphilis and neurosyphilis from the list of possible diagnoses. "Neurosyphilis is not as common as it once was," Dr. Burks explains. "This is because syphilis, the forerunner of neurosyphilis, is so readily treatable today."
VASCULAR DISEASES THAT MIMIC MS
Stroke symptoms include sudden trouble with vision in one or both eyes, sudden trouble walking, dizziness, loss of coordination, sudden severe headache, confusion, trouble speaking or understanding, sudden nausea, fever, vomiting or loss of consciousness.
"Strokes can be caused by bleeding in the brain or by blood clots that cut off the blood supply to an area of the brain," Burks explains. "The result is that neurons in the brain die. Major strokes cause very obvious losses in function and are unlikely to be confused with MS. However, smaller strokes can produce changes or loss in function that can look similar to a MS attack. Many people with MS have first been misdiagnosed with stroke."
Central nervous system (CNS) Angitis, an inflammation of the blood vessels of the brain, can produce headache, confusion, and other neurologic deficits that slowly progress.
Dural Arteriovenous Fistulas are abnormal structures of blood vessels along the spinal cord that deprive the spinal cord of blood, resulting in weakness, bladder and bowel changes, and sensory symptoms, all of which appear in a relapsing or progressive manner. MRI of the spinal cord or spinal angiography may be required to confirm diagnosis.
Binswanger's is a cerebrovascular disease usually seen in older patients with high blood pressure. Demyelination of the white matter surrounding the brain, similar to white matter lesions seen in MS, can appear with this disease.
Other diseases are occasionally confused with MS. These include fibromyalgia and vitamin B12 deficiency, muscular dystrophy (MD), amyotrophic lateral sclerosis (ALS or Lou Gehrig's disease), migraine, hypo-thyroidism, hypertension, Beçhets, Arnold-Chiari deformity, and mitochondrial disorders, although your neurologist can usually rule them out quite easily.
Fibromyalgia involves pain and fatigue of the muscles, ligaments and tendons. Muscular pain can be shooting or throbbing. Burning, stiffness, fatigue, face and head pain, cognitive impairment, numbness, tingling, dizziness and impaired coordination are common. Changes in weather, hormonal fluctuations, stress or depression can all contribute to symptom flare-ups.
"Although fibromyalgia does mimic MS, it will not show up on an MRI or even be observable at an exam," Burks says. "Fibromyalgia is very non-specific."
Vitamin B12 deficiency may cause demyelination, numbness and tingling of the hands and feet, fatigue, weakness, and in extreme cases, change in mental status. "There is a theory that vitamin B12 can actually produce more myelin, so people with MS may assume that they need more of it," Burks says. "But B12 is only beneficial if you have a deficit to begin with."
A FINAL WORD.
"While MS may have many mimics, a neurologist can usually make a correct diagnosis early in the disease by taking a careful history, doing a complete neurological exam, looking at the MRI, and sometimes, evaluating the spinal fluid," Dr. Burks states. "If you are concerned about your diagnosis, you can discuss your concerns with your neurologist and possibly get referred for a second opinion from a MS expert at a comprehensive MS center. The Multiple Sclerosis Foundation can help you locate a MS center in your area."
Info found on MSFacts (dot) org