MRT with contrast medium
In order to be able to see exactly what the lesions are, it is important that an MRI of the brain is also done with the help of a contrast medium (usually gadolinium). This contrast medium is injected into the vein and is then distributed throughout the body, including the brain. Here the contrast medium accumulates mainly in those parts of the brain that are particularly metabolically active.
Since the lesions in the brain caused by multiple sclerosis are metabolically active areas in MS, a particularly large amount of contrast medium accumulates here. This can then be seen particularly well on the MRI image, and thus multiple sclerosis can also be detected much better by the contrast medium in the MRI image than without contrast medium. Especially the active (fresh) areas of MS can be easily distinguished from old lesions (scarring) by the contrast agent. However, since there are some patients who are allergic to contrast medium, it is possible to have the MRI image of the skull taken without contrast medium. Recently, there have been indications that too many contrast medium examinations could lead to accumulation in the brain.
SymptomsInitial stage
The symptoms of multiple sclerosis are quite diverse and difficult to interpret, especially in the early stages. As the protective layer of the nerves is reduced, the symptoms are often due to problems with nerve conduction.Sometimes the most common symptom in a patient suffering from multiple sclerosis is a strange feeling in the arms or legs in the early stages. These sensory disturbances can be noticeable by tingling or a lack of feeling in the arms or legs.
Another very common symptom, especially in young patients in the early stages, is the feeling of not being able to see properly. These visual disturbances usually manifest themselves by the patient complaining that he or she has a veil over the eyes (optic neuritis) as if looking through a frosted glass pane. However, the visual disturbances can also manifest themselves by the patient finding it difficult to look into the distance or by the patient’s difficulty in recognizing nearby objects.
It is therefore difficult to tell at an early stage whether the symptoms are related to multiple sclerosis or whether the patient simply has mild visual problems and needs glasses. That is why it is so important to have an additional MRI examination in a patient with suspected MS, because the lesions in the brain (in this case in the area of the optic nerve) can then be used to assess whether the visual problems could be attributed to multiple sclerosis. The other symptoms are also rather unspecific and therefore difficult to attribute to multiple sclerosis.
On the one hand, the patient may notice that the strength in the muscles either decreases and the patient tires quickly or that a kind of spasticity occurs in which the muscles become very stiff. In addition, coordination problems and/or balance problems may occur. Sexual disorders are also possible, although rare.
Problems with the bladder such as the constant feeling of having to go to the toilet or urinary incontinence are also rare. Some patients are conspicuous by unclear or slurred speech, similar to the patient being drunk and unable to express himself or herself properly. However, this symptom is quite rare and especially occurs very rarely in the early stages.
However, it often happens that the patient is no longer able to control the fingers exactly and therefore it is difficult for him to put his finger on the tip of the nose with his eyes closed, as this requires special fine motor skills, which are often no longer possible in MS patients. In addition to these physical (somatic) symptoms, however, a number of psychological disorders, such as depression or, in rare cases, aggression, can also occur. However, it is important to know that all these symptoms are very general and alone do not constitute a clear diagnosis of multiple sclerosis.
It is much more important to compare the symptoms with the MRI image of the head. If a patient suffers from visual disturbances, the MRI should show a lesion in the area of the visual pathway, which then causes the visual disturbances. If a patient has problems with speech, a lesion should be visible in the MRI in the area of the speech center, which explains the problems with speech. Therefore, for the first symptoms of multiple sclerosis, the MRI is always the method of choice for detection.
