Ms: diagnostic process
Neurological examination
A neurological examination can reveal the location of
lesions in the brain and spinal cord. A physician, usually a
neurologist, will perform a general physical exam that examines all the body's systems, including heart, lungs, abdomen, skin, and joints. The physician will also perform a detailed neurological exam that focuses on detecting specific areas of
nerve damage in the brain and spinal cord. This exam will evaluate the groups of nerves that send messages to and from the brain in the general areas of the head and neck, and the
spinal nerves that send branches to muscles (motor nerves) and receive information from the skin (sensory nerves).
Tests That Reveal Damage to Cranial Nerves
- Smell: tests the ability to identify prominent odors
- Vision: tests the ability to see all fields of vision and move the eyeball in all directions (up, down, left, right) in each eye
- Eye movement: tests the movement of the eyes in all directions, and the ability to follow objects smoothly
- Facial movement: tests the ability to close the eyes and make facial expressions
- Mastication: tests the ability to open and close the mouth
- Hearing: tests the clarity, pitch, and intensity of different sounds
- Balance: tests the ability to walk in a straight line, heel to toe
- Throat function: tests tongue strength, the ability to swallow, and voice quality
Tests That Reveal Damage to Motor Nerves and Sensory Nerves
The strength, tone (normal or spastic), and movement of
muscles in the arms and legs will be examined by looking at how well they move and how they react when pressure is applied against resistance. To examine sensory nerves, the surface of the skin will be touched first by a pin and then using a blunt object, to see if there is any numbness, altered
sensation (such as tingling), or pain.
Tests That Reveal Damage to Areas Controlling Reflexes
The physician will look for absent, diminished, exaggerated, or uneven
reflexes at the knees, elbows, forearms, ankles, and feet. Babinski's reflex is an abnormal reflex that causes an upward curling of the toes after the sole of the foot is stroked.
Tests That Reveal Damage to Areas Controlling Coordination and Gait
To test
coordination and gait the patient is asked to perform maneuvers such as touching his or her nose and the physician's finger in rapid succession. Another exercise known as Romberg's test will check for swaying while the
patient stands with both feet together and both arms outstretched in front, first with eyes open, and then with eyes closed.
MRI
A
magnetic resonance imaging scan (MRI) is the most sensitive method available to detect lesions and show changes in the central nervous system typical of Multiple Sclerosis (MS). MRI can detect more than one lesion in 90 percent of people with MS. It can be used to confirm a diagnosis of MS and to see if the disease has worsened. MRI is particularly useful if symptoms change suddenly. MRI is extremely sensitive and can detect very small
lesions. Sometimes a contrast dye (gadolinium enhancement) is injected into a vein to see if the protective blood-brain barrier has been broken, a common abnormality in people with MS, especially during an attack. Gadolinium enhancement also shows new activity. In some cases, MRI will be normal even though a physical and neurological examination suggests MS.
How does MRI work?
The imaging device circles the body and uses magnets to oscillate
water molecules, then picks up the signals that are released by water to produce a
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