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Thread: MS or ADEM or any other differential diagnosis? Suggestions and comments please.

  1. #1

    Default MS or ADEM or any other differential diagnosis? Suggestions and comments please.

    Here are the reports of my brother-in-law's recent medical intervention. Although diagnosed Multiple Sclerosis (MS), I am not sure if it fulfills the McDonald criteria for MS diagnosis. Is there any possibility of ADEM or any other differential diagnosis? He was infected with chickenpox 2 years ago. During childhood when he was around 12 years old, he had experienced a sudden fall as if he was hit by something behind the legs -- 3 or 4 times. Since then he had been suffering from a sort of drowsiness or lethargy from time to time for short periods during conversation, travelling etc. It did not have any major impact on his lifestyle so far. Now that he has undergone this treatment (still under corticosteroid in small quantity - 40mg for the next 2 weeks), he no longer experiences the feeling of drowsiness or lethargy at all.

    The reason he went to the hospital recently was to treat the minor difficulty in uttering words sometimes which lasted only for less than a minute.
    He could communicate without any problem but sometimes, he was unable to clearly articulate words starting the sentences. This lasted for a few seconds or less than a minute and he would regain the flow of communication. Afterwards, the same problem described above would occur again.
    This problem has not been fully resolved so far although in the morning this occurs less frequently now. Only towards the later part of the day or early hours of night, he experiences the problem in speech mentioned above -- especially after the treatment with corticosteroid has been started.


    "The multifocal FLAIR hyperintense foci involving the bilateral temporal (right > left), bilateral gangliocapsular region, right post central gyrusm left occupital cortex and midbrain tectal plate on left side. The tectal plate lesion shows mild restriction of diffusion"
    --- report of initial MRI by consultant radiologist

    "39 year old male came with c/o dysarthria since 2 months which remained without any progression and there were no other focal neurological defects. MRI (brain) with contrast revealed multiple hyperintense foci in bilateral temporal and basal ganglia and left midbrain tectal plate and left occupital cortex enhancement. CSF study revealed elevated protein and oligoclonal bands. Diagnosed to Multiple Sclerosis and treated with IV methyl prednisolone for 5 days(1g for the first 2 days and 500mg for the next 3 days). Patient condition improved and advised discharge.
    ---- from the discharge summary by consultant neurologist

    Links to the images (MRI) posted:

    http://s25.postimg.org/eq3o72i5b/20131207_195932.jpg
    http://s25.postimg.org/czkn5l0m7/20131207_201002.jpg
    http://s25.postimg.org/opykmyten/20131207_201052.jpg
    http://s25.postimg.org/6bo1izh3z/20131207_201324.jpg
    http://s25.postimg.org/ypth2v4nz/20131207_201345.jpg
    http://s25.postimg.org/sdix6rqzj/20131207_201406.jpg

    Thanks in advance for your valuable suggestions and comments.

    Satheesh M P

  2. #2
    Distinguished Community Member agate's Avatar
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    Hi satheesh, and welcome to this board.

    I'm sorry your brother has been having these medical problems. Unfortunately none of the people on this board is a doctor, and we can't interpret MRIs or MRI reports.

    "Multiple hyperintense lesions" and "oligoclonal bands" are features that often turn up in the test results for people with MS. With a diagnosis of MS, the doctors can't ever be 100% sure, especially at first.

    Your brother could explore other possible diagnoses, maybe get a new doctor, or he could agree to go on treating what the doctor says is MS. If he does that, the doctor is probably going to want to put him on one of the MS drugs that are now available.

    Sorry I can't be more helpful. It's sad but some people don't get a definite diagnosis (or un-diagnosis) for many years.
    Last edited by agate; 12-08-2013 at 10:25 AM. Reason: fixing a mistake
    MS diagnosed 1980. Avonex 2002-2005. Copaxone 6/07 - 5/10.
    Member of this MS board since 2001.

  3. #3
    Distinguished Community Member SalpalSally's Avatar
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    Hello and welcome to the forum, Satheesh. So nice to meet you.
    I have nothing more to add to Agate's correct post. Just wanted
    to welcome you and to wish you and your Brother-in-law well
    Love, Sally


    "The best way out is always through". Robert Frost







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