Why this is not multiple sclerosis: a case based approach

To present a case series of patients previously diagnosed as multiple sclerosis (MS) which were later confirmed as an alternative diagnosis, and describe the clinical and paraclinical signs that led to this change. Nine patients are described. We reviewed the patient's clinical chart, magnetic...

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Published in:	Arquivos de neuro-psiquiatria Vol. 73; no. 12; pp. 985 - 992
Main Authors:	Nicolau, Zaira Fernanda Martinho, Oliveira, Enedina Maria Lobato de, Bichuetti, Denis Bernardi
Format:	Journal Article
Language:	English
Published:	Brazil Academia Brasileira de Neurologia - ABNEURO 01-12-2015 Academia Brasileira de Neurologia (ABNEURO)
Subjects:	Adult clínico Diagnosis, Differential Diagnostic Errors diagnóstico esclerose múltipla Female Humans Magnetic Resonance Imaging Male Middle Aged Multiple Sclerosis - diagnosis NEUROSCIENCES PSYCHIATRY ressonância magnética Young Adult clinical MRI red flags multiple sclerosis clínico diagnosis diagnóstico esclerose múltipla ressonância magnética
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Abstract	To present a case series of patients previously diagnosed as multiple sclerosis (MS) which were later confirmed as an alternative diagnosis, and describe the clinical and paraclinical signs that led to this change. Nine patients are described. We reviewed the patient's clinical chart, magnetic resonance images (MRI) and cerebrospinal fluid. There was a mean of three typical symptoms of MS and four clinical red flags per patient. MRI red flags were found in 88,9% of all referrals, with a mean of 3 encountered per patient. We identified that, not only the misdiagnosed patients did not fulfill MS diagnosis criteria, but also how the described red flags are a useful tool in the differentiation of MS from other diseases. This data is important for guiding future diagnosis, especially for general clinicians and neurologists, which directly interfere with the patient's management, treatment, prognosis and quality of life.
AbstractList	To present a case series of patients previously diagnosed as multiple sclerosis (MS) which were later confirmed as an alternative diagnosis, and describe the clinical and paraclinical signs that led to this change. Nine patients are described. We reviewed the patient's clinical chart, magnetic resonance images (MRI) and cerebrospinal fluid. There was a mean of three typical symptoms of MS and four clinical red flags per patient. MRI red flags were found in 88,9% of all referrals, with a mean of 3 encountered per patient. We identified that, not only the misdiagnosed patients did not fulfill MS diagnosis criteria, but also how the described red flags are a useful tool in the differentiation of MS from other diseases. This data is important for guiding future diagnosis, especially for general clinicians and neurologists, which directly interfere with the patient's management, treatment, prognosis and quality of life. Objective To present a case series of patients previously diagnosed as multiple sclerosis (MS) which were later confirmed as an alternative diagnosis, and describe the clinical and paraclinical signs that led to this change. Method Nine patients are described. We reviewed the patient’s clinical chart, magnetic resonance images (MRI) and cerebrospinal fluid. Results There was a mean of three typical symptoms of MS and four clinical red flags per patient. MRI red flags were found in 88,9% of all referrals, with a mean of 3 encountered per patient. Conclusion We identified that, not only the misdiagnosed patients did not fulfill MS diagnosis criteria, but also how the described red flags are a useful tool in the differentiation of MS from other diseases. This data is important for guiding future diagnosis, especially for general clinicians and neurologists, which directly interfere with the patient’s management, treatment, prognosis and quality of life. Objetivo Apresentar uma série de casos de pacientes previamente diagnosticados como esclerose múltipla (EM) que tiveram um diagnóstico final alternativo, e descrever os sinais clínicos e paraclínicos que levaram à esta mudança. Método Nove pacientes encaminhados para confirmação diagnóstica de EM. Revisamos os prontuários, imagens de ressonância magnética (MRI) e líquido cefalorraquidiano. Resultados Houve uma média de três sintomas típicos de EM e quatro sinais de alerta por paciente. Sinais de alerta de ressonância magnética foram encontrados em 88,9% dos casos, com média de 3 por paciente. Conclusão Identificou-se que, não só os pacientes com diagnóstico incorreto não cumprem critérios de diagnóstico, mas também como os sinais de alerta já descritos são uma ferramenta útil na diferenciação de EM de outras doenças. Esta informação é importante para orientar a assertividade diagnóstica, especialmente para os clínicos e neurologistas gerais, com interferencia direta no tratamento, prognóstico e qualidade de vida do paciente. Objective To present a case series of patients previously diagnosed as multiple sclerosis (MS) which were later confirmed as an alternative diagnosis, and describe the clinical and paraclinical signs that led to this change. Method Nine patients are described. We reviewed the patient’s clinical chart, magnetic resonance images (MRI) and cerebrospinal fluid. Results There was a mean of three typical symptoms of MS and four clinical red flags per patient. MRI red flags were found in 88,9% of all referrals, with a mean of 3 encountered per patient. Conclusion We identified that, not only the misdiagnosed patients did not fulfill MS diagnosis criteria, but also how the described red flags are a useful tool in the differentiation of MS from other diseases. This data is important for guiding future diagnosis, especially for general clinicians and neurologists, which directly interfere with the patient’s management, treatment, prognosis and quality of life. OBJECTIVETo present a case series of patients previously diagnosed as multiple sclerosis (MS) which were later confirmed as an alternative diagnosis, and describe the clinical and paraclinical signs that led to this change.METHODNine patients are described. We reviewed the patient's clinical chart, magnetic resonance images (MRI) and cerebrospinal fluid.RESULTSThere was a mean of three typical symptoms of MS and four clinical red flags per patient. MRI red flags were found in 88,9% of all referrals, with a mean of 3 encountered per patient.CONCLUSIONWe identified that, not only the misdiagnosed patients did not fulfill MS diagnosis criteria, but also how the described red flags are a useful tool in the differentiation of MS from other diseases. This data is important for guiding future diagnosis, especially for general clinicians and neurologists, which directly interfere with the patient's management, treatment, prognosis and quality of life. Objective To present a case series of patients previously diagnosed as multiple sclerosis (MS) which were later confirmed as an alternative diagnosis, and describe the clinical and paraclinical signs that led to this change. Method Nine patients are described. We reviewed the patient's clinical chart, magnetic resonance images (MRI) and cerebrospinal fluid. Results There was a mean of three typical symptoms of MS and four clinical red flags per patient. MRI red flags were found in 88,9% of all referrals, with a mean of 3 encountered per patient. Conclusion We identified that, not only the misdiagnosed patients did not fulfill MS diagnosis criteria, but also how the described red flags are a useful tool in the differentiation of MS from other diseases. This data is important for guiding future diagnosis, especially for general clinicians and neurologists, which directly interfere with the patient's management, treatment, prognosis and quality of life.Original Abstract: Objetivo Apresentar uma serie de casos de pacientes previamente diagnosticados como esclerose multipla (EM) que tiveram um diagnostico final alternativo, e descrever os sinais clinicos e paraclinicos que levaram a esta mudanca. Metodo Nove pacientes encaminhados para confirmacao diagnostica de EM. Revisamos os prontuarios, imagens de ressonancia magnetica (MRI) e liquido cefalorraquidiano. Resultados Houve uma media de tres sintomas tipicos de EM e quatro sinais de alerta por paciente. Sinais de alerta de ressonancia magnetica foram encontrados em 88,9% dos casos, com media de 3 por paciente. Conclusao Identificou-se que, nao so os pacientes com diagnostico incorreto nao cumprem criterios de diagnostico, mas tambem como os sinais de alerta ja descritos sao uma ferramenta util na diferenciacao de EM de outras doencas. Esta informacao e importante para orientar a assertividade diagnostica, especialmente para os clinicos e neurologistas gerais, com interferencia direta no tratamento, prognostico e qualidade de vida do paciente.
Author	Bichuetti, Denis Bernardi Nicolau, Zaira Fernanda Martinho Oliveira, Enedina Maria Lobato de
AuthorAffiliation	Universidade Federal de São Paulo
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Snippet	To present a case series of patients previously diagnosed as multiple sclerosis (MS) which were later confirmed as an alternative diagnosis, and describe the... Objective To present a case series of patients previously diagnosed as multiple sclerosis (MS) which were later confirmed as an alternative diagnosis, and... OBJECTIVETo present a case series of patients previously diagnosed as multiple sclerosis (MS) which were later confirmed as an alternative diagnosis, and...
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SubjectTerms	Adult clínico Diagnosis, Differential Diagnostic Errors diagnóstico esclerose múltipla Female Humans Magnetic Resonance Imaging Male Middle Aged Multiple Sclerosis - diagnosis NEUROSCIENCES PSYCHIATRY ressonância magnética Young Adult
Title	Why this is not multiple sclerosis: a case based approach
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