How common is Multiple Sclerosis in two twins?
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How common is it for two twins to both be diagnosed with Multiple Sclerosis due to brain lesions being seen on MRI? Are doctors missing something ? Would MRI detect vasculitis?
Posted Thu, 13 Feb 2014 in Brain and Spine
Answered by Dr. Sudhir Kumar 34 minutes later
Brief Answer: My reply is below. Detailed Answer: Hi, Thank you for posting your query. I appreciate your query, as it is an interesting and intelligent query. About 10% of twins may have multiple sclerosis (which fulfil MRI as well as clinical criteria for the diagnosis of MS). So, it means it is not common to have two twins to have a diagnosis of MS (90% of twins do not have this diagnosis together). Irrespective of the relationship of twins, each of them needs to be assessed and evaluated in detail to confirm the diagnosis of MS. As you rightly said, we need to exclude alternate diagnosis of vasculitis. MRI is not specific for a diagnosis of vasculitis. MR angiogram and DSA (angiogram of cerebral vessels) may be required to further evaluate for vasculitis, especially if the MRI is not typical for MS. I hope my answer helps. Please get back if you have any follow up queries or if you require any additional information. Wishing you good health, Dr Sudhir Kumar MD (Internal Medicine), DM (Neurology) XXXXXXX Consultant Neurologist Apollo Hospitals, Hyderabad, India Click on this link to ask me a DIRECT QUERY: http://bit.ly/Dr-Sudhir-kumar My BLOG: http://bestneurodoctor.blogspot.in
Follow-up: How common is Multiple Sclerosis in two twins? 53 minutes later
So an MRI with contrast could detect vasculitis? We worry because our aunt and uncle died young from stroke and brain aneurism. How is a dsa performed? Is there any risk to it? I attached my mri without contrast. I cant find the other one with contrast although there was no change in 4 months. I suffer with chronic uveitis in my left eye and during an exam once the radiologist said to me the blood vessels are affected so im worried.
Answered by Dr. Sudhir Kumar 59 minutes later
Brief Answer: Thank you for getting back. Detailed Answer: MRI with contrast could give us clues towards vasculitis, however, the diagnosis of vasculitis can not be confirmed with that. DSA is performed by insuring a catheter in the groin, and injecting XXXXXXX in the brain vessels. This procedure is fairly safe. Your MRI has not been attached here. As I mentioned, we can exclude vasculitis in your case with investigations (as mentioned in the first reply). Best wishes, Dr Sudhir Kumar MD DM (Neurology)
Follow-up: How common is Multiple Sclerosis in two twins? 4 minutes later
As a neurologist would you think by this result definate MS? I have to do a LP but what are all the tests for MS?
Answered by Dr. Sudhir Kumar 6 minutes later
Brief Answer: Thank you for getting back. Detailed Answer: Yes, the most likely diagnosis on the basis of MRI would be MS, however, there is no active lesion, as contrast enhancement is not seen and there are no new lesions. For MS diagnosis, other tests would be MRI of cervical spine with contrast, CSF analysis to look for oligoclonal bands and VEP (visual evoked potential) studies. Best wishes, Dr Sudhir Kumar MD DM (Neurology)
Follow-up: How common is Multiple Sclerosis in two twins? 2 minutes later
EEG was normal and MRI of Spine was normal except i do show sacriolitis. No lesions. Delayed evoke responses in one ankle but i have lower back issues and also im low iron. The mri before this one was 4 months earlier.
Answered by Dr. Sudhir Kumar 12 minutes later
Follow-up: How common is Multiple Sclerosis in two twins? 3 minutes later
One last question i promise... Do lesions with vasculitis look like ms lesions or do ms lesions look different. And in vasculitis do lesions appear in corpus collosum? And thankyou for all your time. I would like to be able to keep in touch. I tried those links but my smart phone wont let me use the links.
Answered by Dr. Sudhir Kumar 3 minutes later
Brief Answer: Thank you for getting back. Detailed Answer: Lesions in MS and vasculitis do look different. In MS, lesions are mainly seen in the white matter and sub-cortical structures. Whereas, in vasculitis, lesions can occur in white as well as grey matter, and the cortex may be affected. More importantly, in vasculitis, the blood vessels are affected, however, in MS, they are spared. Corpus callosum is typically involved in MS, and is very rarely involved in vasculitis. I would be pleased to be in touch with you and be of nay help to you in future too. Best wishes, Dr Sudhir Kumar MD DM (Neurology)