Fast Five Quiz: Commonly Misdiagnosed Conditions

B.S. Anand, MD; Michael Stuart Bronze, MD; Herbert S. Diamond, MD; Helmi L. Lutsep, MD


June 02, 2021

Traditionally, MS could not be diagnosed after only a single symptomatic episode, as diagnosis required the occurrence of repeat clinical attacks, suggesting the appearance of lesions separated in time and space; however, recent guidelines allow diagnosis of MS even with a first clinical episode, as long as supporting evidence is also found. According to the 2017 McDonald criteria, one attack along with objective clinical evidence of one lesion can lead to diagnosis, provided dissemination in space and time is demonstrated by MRI.

A common misconception is that any attack of central nervous system demyelination means a diagnosis of acute MS. A patient who has a first attack of demyelination should not be immediately diagnosed with MS, because the differential diagnosis includes numerous other diseases.

Urinary symptoms are common in MS, with most patients experiencing problems at some point in their disease. Bladder problems are a source of significant morbidity, affecting the person's family, social, and work responsibilities. Bladder dysfunction can be classified as failure to store, failure to empty, or both. Patients with impaired storage have a small, spastic bladder with hypercontractility of the detrusor muscle. Symptoms experienced may include urgency, frequency, incontinence, and nocturia.

Although MRI alone cannot be used to diagnose MS, it remains the imaging procedure of choice for confirming MS and monitoring disease progression in the brain and spinal cord. MRI is not specific, but it is considered the most sensitive imaging modality for diagnosing spinal cord MS, evaluating its extent, and following up the response to treatment.

Read more about the diagnoses of MS.