Why MS Is Diagnosed Quickly in Some Patients—And Missed in Others: A Neurology Expert Explains

Dr. Sicotte explains that the most rapid MS diagnoses are usually seen in young people with classic symptoms of optic neuritis, inflammation of the optic nerve. There are two optic nerves, one in the back of each eye, which transmit messages to the brain.

“This type of inflammation leads to a pretty dramatic change in vision in one eye with pain on eye movement, and that almost inevitably will brings someone to medical attention, usually an ophthalmologist, and our ophthalmology colleagues are very cognizant of the fact that this could be a presenting sign of MS,” Dr. Sicotte says.

An ophthalmologist (eye and vision doctor) will often order an MRI with and without contrast, which provides detailed images of the brain and the optic nerves.

“If we see [that] the MRI shows those telltale signs, then the patient can be referred very quickly to a neurologist who can have the information they need in order to make a diagnosis,” Dr. Sicotte says.

She notes that patients who present with optic neuritis often have a better outlook, likely because their symptoms are recognized quickly, allowing them to see the right specialists sooner, receive a diagnosis, and start treatment earlier.

Why MS Is Often Diagnosed Later in Men & Black Populations

“I would say the patients that take the longest would be maybe an atypical patient. Previously, there was a notion that only white women were affected by MS. We know this is absolutely not the case and that Black or African-American populations are very commonly impacted, and men can also be diagnosed,” Dr. Sicotte says.

Although MS is less common in men, they still make up roughly one-third of those living with the disease.

In some cases, men may downplay or overlook symptoms—particularly when they are intermittent—which can lead them to delay seeking care and ultimately postpone diagnosis, Dr. Sicotte further explains.

Meanwhile, symptoms that are non-specific and can occur briefly in anyone—such as numbness or tingling—Dr. Sicotte says some people may attribute that to a pinched nerve.

Overlooked Symptoms Delay Diagnoses

What can make it challenging for patients to recognize is that MS symptoms often fluctuate—they may appear suddenly, last for days or weeks, then fade away before returning again later.

Dr. Sicotte adds, “So someone might think, ‘Oh, I just had some weird, you know, pinched nerve and now it’s gone.’ And so those kinds of symptoms can sometimes be ignored.”

Other symptoms that may be ignored because most are so common:

• Fatigue
• Depression
• Brain Fog
• Sensory Issues

MS: Understanding Symptoms

Dr. Lauren Krupp, a neurologist at NYU Langone in New York City, describes MS as an “immune mediated condition,” which causes the immune system to work against itself.

“We’re not exactly sure why that happens, but it probably has to do with an exposure to a virus at some point in time. And in the effort to fight off that virus, the immune system turns against itself and specifically, a coating of the nerves called myelin,” Dr. Krupp tells SurvivorNet. “The myelin that it affects involves the central nervous system, and that’s the brain and the spinal cord.”

Because it can involve different areas in the brain or spinal cord, Dr. Krupp explains, “the symptoms can vary in location.”

Symptoms might include:

• Numbness and tingling in the face
• Numbness or weakness in the arms and legs
• A sensation of vertigo or rooms spinning
• Vision loss or blurred vision
• Lack of coordination

Symptoms may affect one side of the body or, when the spinal cord is involved, both sides. In some cases, the numbness can spread and may also come with muscle weakness.

“Usually we see people who have had some neurological symptoms and they often get worked up with an MRI of the brain … the brain MRI is a really important tool,” Dr. Krupp adds.

Contributing: SurvivorNet Staff

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