Misdiagnosis of Multiple Sclerosis
Misdiagnosis of Multiple Sclerosis
A diagnosis of multiple sclerosis can be elusive because symptoms, such as fatigue, muscle weakness, and dizziness, can be vague. Symptoms can also vary greatly between individuals and mimic other diseases. Because of these factors, a diagnosis of the condition may be delayed or overlooked.
There is no single test that will specifically diagnose the multiple sclerosis. A definitive diagnosis of multiple sclerosis is made by a neurologist after performing a thorough neurological history and physical examination and multiple tests to rule out other conditions that can be confused with multiple sclerosis. These conditions include some viral infections, lupus, lime disease, and vitamin deficiencies. Tests may include blood tests, a lumbar puncture, and an MRI, which may show the brain and spinal cord damage and lesions characteristic of multiple sclerosis....more about Multiple Sclerosis »
Alternative diagnoses list for Multiple Sclerosis:
For a diagnosis of Multiple Sclerosis,
the following list of conditions
have been mentioned in sources
as possible alternative diagnoses
to consider during the diagnostic process for Multiple Sclerosis:
Diseases for which Multiple Sclerosis may be an alternative diagnosis
The other diseases for which Multiple Sclerosis
is listed as a possible alternative
diagnosis in their lists include:
Rare Types of Multiple Sclerosis:
Multiple Sclerosis: Medical Mistakes
Related medical mistakes may include:
Multiple Sclerosis: Undiagnosed Conditions
Commonly undiagnosed conditions in related areas may include:
Common Misdiagnoses and Multiple Sclerosis
Thigh tingling need not be multiple sclerosis: There is a fairly common nerve condition
called meralgia paresthetica that typically results in symptoms such as thigh tingling or thigh numbness.
It is a form of nerve symptom, and usually has fairly simple treatments and good prognosis.
For such symptoms, the other possibilities nevertheless do include multiple sclerosis
or other spinal nerve conditions.
See introduction to meralgia paresthetica and introduction to multiple sclerosis.
Multiple sclerosis often misdiagnosed as mental disorder: The early stages of multiple sclerosis may cause
various general feelings of wellness, happiness, euphoria, or manic-type symptoms
in some patients.
These symptoms may lead to a misdiagnosis of bipolar disorder (manic-depressive disorder),
hypomania, cyclothymia, histrionic personality disorder, or similar disorders.
Other patients may show depressive symptoms as part of Multiple sclerosis
and risk a misdiagnosis of depression (i.e. non-bipolar unipolar depression).
Other possible misdiagnoses of multiple sclerosis include somatization disorder,
conversion disorder, neurotic disorders, or other psychological disorders.
See the overview of multiple sclerosis.
Cluster of diseases with difficult diagnosis issues: There is a well-known list of
medical conditions that are all somewhat difficult to diagnose, and all can present
in a variety of different severities.
Diseases in this group include multiple sclerosis, lupus, Lyme disease, fibromyalgia,
thyroid disorders (hypothyroidism or hyperthyroidism),
chronic fatigue syndrome, diabetes - all of these can have vague symptoms in their early presentations.
Also, depression can have some symptoms similar to these conditions, and also the reverse,
that many of these conditions can mimic depression and be misdiagnosed as depression.
Undiagnosed stroke leads to misdiagnosed aphasia: BBC News UK reported on a man who
had been institutionalized and treated for mental illness
because he suffered from sudden inability to speak.
This was initially misdiagnosed as a "nervous breakdown" and other mental conditions.
He was later diagnosed as having had a stroke, and suffering from aphasia (inability to speak),
a well-known complication of stroke (or other brain conditions).
Dementia may be a drug interaction: A common scenario in aged care is for
a patient to show mental decline to dementia.
Whereas this can, of course, occur due to various medical conditions,
such as a stroke or Alzheimer's disease,
it can also occur from a side effect or interaction between multiple drugs
that the elderly patient may be taking.
There are also various other possible causes of dementia.
Mild traumatic brain injury often remains undiagnosed: Although the symptoms
of severe brain injury are hard to miss,
it is less clear for milder injuries, or even those causing a mild concussion diagnosis.
The condition goes by the name of "mild traumatic brain injury" (MTBI).
MTBI symptoms can be mild, and can continue for days or weeks after the injury.
See the symptoms of MTBI or misdiagnosis of MTBI.
MTBI misdiagnosed as balance problem: When a person has symptoms
such as vertigo or dizziness, a diagnosis of brain injury may go overlooked.
This is particularly true of mild traumatic brain injury (MTBI), for which the
symptoms are typically mild. The symptoms has also relate to a relatively
mild brain injury (e.g. fall), that could have occurred days or even weeks ago.
Vestibular dysfunction, causing vertigo-like symptoms, is a common complication
of mild brain injury.
See causes of dizziness, causes of vertigo, or misdiagnosis of MTBI.
Brain pressure condition often misdiagnosed as dementia: A condition
that results from an excessive pressure of CSF within the brain is often misdiagnosed.
It may be misdiagnosed as Parkinson's disease or dementia (such as Alzheimer's disease).
The condition is called "Normal Pressure Hydrocephalus" (NPH) and is caused by having
too much CSF, i.e. too much "fluid on the brain".
One study suggested that 1 in 20 diagnoses of dementia or Parkinson's disease were actually NPH.
See misdiagnosis of Alzheimer's disease or misdiagnosis of Parkinson's disease.
Post-concussive brain injury often misdiagnosed: A study found that soldiers who had
suffered a concussive injury in battle often were misdiagnosed on their return.
A variety of symptoms can occur in post-concussion syndrome and these were not being correctly
attributed to their concussion injury.
See introduction to concussion.
Children with migraine often misdiagnosed: A migraine often fails to be
correctly diagnosed in pediatric patients.
These patients are not the typical migraine sufferers, but migraines can also occur in children.
See misdiagnosis of migraine or introduction to migraine.
Vitamin B12 deficiency under-diagnosed: The condition of Vitamin B12 deficiency
is a possible misdiagnosis of various conditions, such as multiple sclerosis (see symptoms of multiple sclerosis).
See symptoms of Vitamin B12 deficiency or misdiagnosis of multiple sclerosis.
Multiple Sclerosis: Rare Types
Rare types of medical disorders and diseases in related medical areas:
Failure To Diagnose Multiple Sclerosis
Failure to diagnose Multiple Sclerosis may be associated with the following:
- Multiple sclerosis can vary greatly in severity which can make diagnosis difficult. Some people actually have no obvious symptoms their whole life and multiple sclerosis lesions may only incidentally be discovered during an MRI
- The range and rate of progression of presenting symptoms for multiple sclerosis is extensive and often mimics other conditions which means that is often misdiagnosed a number of times before the actual cause is determined
- Diagnostic difficulty is increased by the fact that many of the conditions that can be caused by multiple sclerosis may also exist independently of the disease. Examples include optic neuritis, acute disseminated encephalitis and acute transverse myelitis. When these condition present, health professionals need to investigate further in order to exclude multiples sclerosis as a diagnosis
- Early diagnosis of multiple sclerosis allows timely treatment which can impact greatly on the quality of life
- Multiple sclerosis is often undiagnosed or misdiagnosed if it occurs before the age of 20 or after the age of 50 as it is rare in these age brackets. As children are less likely to bring attention to any symptoms, they are more likely to remain undiagnosed, especially in cases where the symptoms come and go. Even if the symptoms are brought to the attention of a parent, they may be dismissed as harmless. For example, if a child complains of a vision problem, the parent may just assume that a foreign body has irritated it and it will heal on its own. Some of the symptoms that can occur in children are vision problems, weakness on one side of the body, incoordination, sleepiness, confusion and poor academic performance due to cognitive problems
- Delayed diagnosis of multiple sclerosis can result in permanent vision impairment
- People with undiagnosed multiple sclerosis are unaware that they need to avoid factors that can exacerbate their condition e.g. infectious diseases
- Cognitive impairment caused by multiple sclerosis is often overlooked as it tends to be mild and somewhat subjective. Cognitive symptoms include impaired concentration, memory, judgement and attention
- Multiple sclerosis can take many years to diagnose in patients where the symptoms tend to appear for a period of time, spontaneously disappear and then reappear
- Some doctors delay treatment in newly diagnosed MS patients in order to determine the type of MS by the progression of symptoms. However, the benefits of this needs to be weighed up against the fact that delaying treatment can lead to and increased progression of disability and increased damage. Some health professionals believe that patients are being treated unnecessarily or for an unnecessary length of time. It is difficult to assess what effect treatment has in the long term prognosis as the progression of the disease is so variable that relapses may be due to treatment or spontaneous remission. More research needs to be done to determine the impact of treatment on the final outcome for various types of MS
- Non-specific sensory symptoms (e.g. limb heaviness, stiffness or pain) make early diagnosis of MS difficult
- There is no definitive test for MS which makes diagnosis difficult. Further investigative testing is often avoided due to expense
Notes On Hidden Causes Of Multiple Sclerosis
The following may be hidden causes of Multiple Sclerosis:
- The exact cause is unknown in most cases but there are many theories
- Some cases of multiple sclerosis (10-20%) appear to be inherited in a familial pattern
- Some researchers believe that some people are genetically predisposed to developing multiple sclerosis but it will only occur when certain triggers are present e.g. environmental factors. Certain viruses and bacteria have been implicated as possible triggers e.g. Epstein-Barr virus
- Research suggests that there is a link between living in a temperate climate during childhood (up to 15 years of age) and an increased risk of developing multiple sclerosis. A temperate climate is a climate that is quite stable and generally doesn't involve the extremities of weather conditions. Thus people who grew up in tropical areas appear less prone to multiple sclerosis. Moving to a temperate climate during adulthood does not appear to increase the risk of MS. Some researchers believe that the specific factors involved may be the protective effect of sunlight exposure and resultant vitamin D levels
- Other researchers believe that a faulty immune system is the cause of the condition
- Some researchers believe that viral infections can trigger an episode as can immune system changes such as occurs in the period after a pregnancy
- Recent studies indicate that there is no link between hepatitis B vaccination during childhood and an increased risk of developing MS
- There is still disagreement over whether factors such as allergic responses, immunization, physical stress, emotional stress and trauma can exacerbate or trigger and attack of multiple sclerosis
- Infections (e.g. common cold, gastroenteritis, influenza) can exacerbate or trigger and attack of MS
Notes On Wrong Diagnosis Of Multiple Sclerosis
Wrong diagnosis of Multiple Sclerosis may be associated with the following:
- Often conditions similar to multiple sclerosis are wrongly diagnosed as multiple sclerosis. Examples include lupus, Lyme disease, Devic disease and neuromyelitis optica
- MS patients may be misdiagnosed as suffering from psychiatric disorders such as anxiety, somatization or conversion
- Sometimes patients with B12 deficiency may be misdiagnosed as having MS which has serious repercussions as they won't receive treatment which can lead to recovery
- British researchers are discovering a significant number of people who have been diagnosed with MS actually have Hughes syndrome (antiphospholipid syndrome) which can mimic the symptoms of MS. This misdiagnosis is serious as Hughes syndrome is easily treated but if untreated can have serious consequences such as wheelchair dependence or stroke
- MS can be difficult to diagnose and it is sometimes diagnosed in cases where other possible causes have been eliminated. Diagnosis by using the process of elimination is a common cause of wrong diagnosis. In fact, people are often diagnosed as definitely having MS, definitely having MS and possibly having MS
- Sometimes a condition called myalgic encephalitis (ME or ICD-DFS) is misdiagnosed as multiple sclerosis (especially the primary progressive form) as they may have similar symptoms
Complications Of Misdiagnosis Of Multiple Sclerosis
The following may be complications of misdiagnosis of Multiple Sclerosis:
- Early vision problems caused by multiple sclerosis may be diagnosed simply as a vision problem due to old age or some other condition rather than multiple sclerosis
- Some MS patients have an initial presentation of neuropsychological complaints (mood disturbance, history of depression, memory impairment, dysphasia and dysgraphia) which may be misdiagnosed as a psychological disorder
Other Notes On Misdiagnosis Of Multiple Sclerosis
- Females are twice as likely to get multiple sclerosis as males
Medical news summaries about misdiagnosis of Multiple Sclerosis:
The following medical news items
are relevant to misdiagnosis of Multiple Sclerosis:
Misdiagnosis and Multiple Sclerosis deaths
Multiple Sclerosis is a condition
that can possibly be deadly if misdiagnosed...more »
General Misdiagnosis Articles
Read these general articles with an overview of misdiagnosis issues.
When checking for a misdiagnosis of Multiple Sclerosis
or confirming a diagnosis of Multiple Sclerosis,
it is useful to consider what other
medical conditions might be possible misdiagnoses or other alternative
conditions relevant to diagnosis.
These alternate diagnoses of Multiple Sclerosis may already have
been considered by your doctor or may need to be considered as possible
alternative diagnoses or candidates for misdiagnosis of Multiple Sclerosis.
For a general overview of misdiagnosis issues for all diseases,
see Overview of Misdiagnosis.