Investigation in multiple sclerosis include:
- MRI scanning:
- permits the visualisation of the dissemination of lesions in time and space
- will reliably identify plaques in the cortex, brainstem and spinal cord
- gadolinium enhancement improves sensitivity
- CSF:
- permits the detection of intrathecal inflammation
- pleocytosis
- slightly raised protein
- 70% of patients hace a raised IgG - electrophoresis reveals oligoclonal bands in the CSF which are not found on serum electrophoresis
- visual evoked potentials:
- permit the demonstration of conduction changes consistent with demyelination
- are of normal amplitude but show an increased latency in patients who have or have had optic neuritis
- measurement of visual evoked potentials is a good way of demonstrating a previous, often subclinical, episode of demyelination in order to make the diagnosis of multiple sclerosis
- auditory brainstem evoked potentials and somatosensory evoked potentials may also be measured
Before referring a person suspected of having MS to a neurologist, exclude alternative diagnoses by performing blood tests including (1):
- full blood count
- inflammatory markers for example erythrocyte sedimentation rate, C-reactive protein
- liver function tests
- renal function tests
- calcium
- glucose
- thyroid function tests
- vitamin B12
- HIV serology
Do not diagnose MS on the basis of MRI findings alone (1).
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