EAN 2026 | Multiple sclerosis mimics that you do not want to miss in the context of the 2024 McDonald criteria

Yes, we have published this paper recently in the Polish Journal of Neurology and Neurosurgery. Taking into perspective our everyday practice and how we are facing now difficulties with patients, especially patients who come with RIS without obvious signs of multiple sclerosis, then there is the question of whether we should treat them or not. So we focused in this paper on the possible other scenarios, other diagnostic entities that could give white matter abnormalities, hyperintense lesions, that could also theoretically in the beginning be clinically silent but have a totally different implication and different approach to treatment and diagnosis, different prognosis, and so forth. And we focused on those that you really should not miss, that are common in everyday practice, and that actually, and this was shown years ago by the Solomon paper, Andrew Solomon, that they could be diagnosed in MS and even treated, even though they are absolutely non-immunological, like migraine, for instance, or functional disorders, where it used to be called psychogenic. So when the patient has complaints but there is no biology to it other than some functional MRI changes that you don’t routinely check for. But we focused on migraine and the discrimination of MRI pathology between migraine, where you can also have widespread lesions, especially periventricularly like in MS, and also small vessel disease. We did stress that the up-to-date imaging protocol for MS is crucial, and looking for central vein sign, assessing what’s the percentage of CVS-positive lesions on a scan per patient, looking at PRLs, which are highly specific but not so sensitive in MS patients. Only half of the patients will have one PRL, but if you have a PRL, it’s not likely that it’s migraine-related. It’s not likely it’s small vessel disease-related. We also looked at cases of lupus, for instance, and this has been my special subject of interest for many years, patients with neurolupus. The problem is that sometimes neurological manifestations with classic white matter lesions could be the first manifestation of lupus, even without overt signs of lupus pathology, like connective tissue disorder, skin, or lab abnormalities. So it’s very important to look at the patients in the general context and not to miss red flags. And that’s the key message of the paper: you should look out for red flags that we have tried to provide in this manuscript regarding radiology, regarding CSF findings, and other potential biomarkers. So I think it’s going to be useful for those clinicians who are now reluctant to make the diagnosis just based on MRI, to convince them that if they assess MRI adequately with enough strength of the scanner, so three Tesla, using novel biomarkers, novel sequences, they can be reassured that they can make the diagnosis of biological MS and treat the patients if they are active on MRI, preventing further disease progression.

This transcript is AI-generated. While we strive for accuracy, please verify this copy with the video.