Central nervous system infectious diseases mimicking multiple sclerosis: recognizing distinguishable features using MRI

Abstract

Sclerosis (MS) Diagnosis (McDonald criteria, 2011) 1 have confirmed the important role of magnetic resonance imaging (MRI) in the diagnosis of MS, especially for patients who present with clinically isolated syndromes (CIS), because this technique allows the dissemination in space (DIS) and the dissemination in time (DIT) to be characterized in a single scan.The determination of DIS is based on the demonstration of at least 1 T2/FLAIR lesion in at least two of the four characteristic locations for MS (juxtacortical, periventricular, infratentorial, and spinal cord), excluding the symptoma tic lesions in the brainstem or spinal cord (Figure 1). The DIT criteria are based on the histopathological diversity of early MS, in which multifocal chronic plaques often coexist with a few ABStrACtThe current diagnostic criteria for multiple sclerosis (MS) confirm the relevant role of magnetic resonance imaging (MRI), supporting the possibility of characterizing the dissemination in space (DIS) and the dissemination in time (DIT) in a single scan. To maintain the specificity of these criteria, it is necessary to determine whether T2/FLAIR visible lesions and the gadolinium enhancement can be attributed to diseases that mimic MS. Several diseases are included in the MS differential diagnosis list, including diseases with exacerbation, remitting periods and numerous treatable infectious diseases, which can mimic the MRI features of MS. We discuss the most relevant imaging features in several infectious diseases that resemble MS and examine the primary spatial distributions of lesions and the gadolinium enhancement patterns related to MS. Recognizing imaging "red flags" can be useful for the proper diagnostic evaluation of suspected cases of MS, facilitating the correct differential diagnosis by assessing the combined clinical, laboratory and MR imaging information.Keywords: central nervous system infections, multiple sclerosis, differential diagnosis, magnetic resonance imaging, MRI. rESUMO Os critérios diagnósticos atuais para a esclerose múltipla (EM) destacam a ressonância magnética (RM) e reforçam a caracterização de disseminação no espaço e no tempo, mesmo em um único exame. Para preservar a especificidade desses critérios é necessário determinar se as lesões identificadas em T2/FLAIR e o realce pelo gadolínio não são devidos a doenças que mimetizam EM. Várias doenças compõem a lista de diagnósticos diferenciais da EM, incluindo algumas com períodos de exacerbação e remissão, além de doenças infecciosas tratáveis, que podem imitar suas características de RM. Discutiremos as características de imagem mais relevantes de diversas neuroinfecções que mimetizam EM, examinando a distribuição espacial das lesões e os padrões de realce pelo gadolínio. O reconhecendo dos sinais de alerta por imagem pode ser útil para a avaliação diagnóstica de casos suspeitos de EM, conduzindo ao diagnóstico diferencial correto através de uma avaliação combinada da clínica, laboratório e imagem.Palavras-Chave: infecções do sistema nervoso central...

Diagnosis of multiple sclerosis: 2017 revisions of the McDonald criteria

“…In Latin America, infectious diseases and nutritional deficiencies also remain important. 28 Several studies support the applicability of the 2010 McDonald Criteria in children. [29][30][31][32][33][34][35][36] The McDonald Criteria are generally most applicable for patients 11 years of age or older; special care is needed in patients younger than 11 years old in whom the likelihood of MS is lower.…”

Cerebrospinal fluid data compilation and knowledge-based interpretation of bacterial, viral, parasitic, oncological, chronic inflammatory and demyelinating diseases. Diagnostic patterns not to be missed in neurology and psychiatry

“…All antibodies for which the MS patient had a former systemic infection or immunization 26 can be found synthesized in brain with frequencies between 10% and 30% (see complementary review 4 and references 35,36,37,38,39 ). But the frequencies are extraordenary high for measles antibodies (up to 80%), rubella antibodies ( up to 67%) and VZV antibodies (up to 63%) with a combined frequency for one to three of them, with up to 96% and for the more specific frequency of the diagnostic relevant combination of two to three increased antibody Index values up to 75% of the MS cases individually depending on the total amount of intrathecal IgG 36,39 .…”

Diagnostic Delay of Multiple Sclerosis in a Portuguese Population

“…Regarding the former, they are mainly due to difficulties in recognizing the disease, for instance when clinical or radiological features are atypical. 18,19 Local factors such as different cultures or health care systems (including access to magnetic resonance imaging -MRI) can explain differences across countries. In this sense, it is important to understand which factors are associated with diagnostic delay and how these influences the disease prognosis.…”