Multiple sclerosis
Editor – I read with interest the article ‘Clinical presentation and diagnosis of multiple sclerosis’ by Helen Ford; multiple sclerosis (MS) can present as a ‘stroke mimic’.1
In a patient with MS, diagnosing a stroke can be challenging because early signs of a stroke present themselves as an MS flare-up.
An ischaemic stroke must be treated immediately. This can be done by intravenous injection of recombinant tissue plasminogen activator (rtPA) or mechanical thrombectomy or a combination of both, hence it is important to differentiate between a stroke and MS.
MS flares tend to show up more slowly, usually over hours or days, whereas stroke symptoms are sudden and severe and can occur within a few minutes.
MS patients don’t normally have a complete loss of vision with an MS flare. They usually get cloudy vision or loss of colour saturation. Stroke patients, on the other hand, will often have a complete loss of vision or half of vision in both eyes.
Loss of ability to speak or understand are common symptoms of stroke whereas muscle spasms, pain, and bowel and bladder problems are more common in an MS flare-up.
Electric shock sensations associated with certain movements usually occur in patients with MS.
The necessity for rapid thrombolysis in acute ischaemic stroke may lead to the treatment of patients with conditions mimicking stroke eg multiple sclerosis. Intravenous thrombolysis (IVT) does not lead to significant complications in ‘stroke mimics’ suggesting that the risk for IVT-associated complications in this group is low.2
In some patients, symptoms occurs during sleep or the time from when the patient was last seen to be normal is unknown, limited sequence magnetic resonance imaging (MRI) of the brain can be performed to detect if salvageable penumbra is present (restricted diffusion is present and no change on fluid-attenuated inversion recovery (FLAIR) images).
Sometimes, the aetiology of white matter lesions is not clear. Typically, MS lesions in the brain are perivenular and a small vein occupies the centre of the MS plaque.3 7 Tesla MRI of the brain demonstrates the presence of a central vessel in 87% of visible white matter lesions called the ‘central vein sign’.4
- © Royal College of Physicians 2020. All rights reserved.
References
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- Ford H.
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- Kostulas N
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- Tan IL
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