title: Diagnostic problems in "clinically definite" multiple sclerosis patients with normal CSF and multiple MRI abnormalities.
abstract: Among patients who underwent cerebrospinal fluid (CSF) and magnetic resonance imaging (MRI) examination during a 5-year period, we found 18 patients at the multiple sclerosis center of the University of Rome and clinically definite multiple sclerosis, MRI white matter abnormalities, normal CSF examination, a disease duration of at least 1 year and an upper age of < 45 years at onset These patients were examined again with a variety of tests screening for different diseases mimicking multiple sclerosis. Alternative diagnoses reached after laboratory tests were: Lyme disease, two cases of vasculitis, mitochondrial encephalomyopathy, multiple ischemic lesions caused by atrial septum aneurysm and olivopontocerebellar atrophy. Hence, six of these 18 patients had a final diagnosis other than multiple sclerosis, while 12 remained with a final diagnosis of "MS with normal CSF". Our study suggests that in patients with a clinical picture of multiple sclerosis and disseminated white matter MRI lesions but no CSF abnormalities, the classical clinical criteria may not be sufficiently specific, unless confirmed by a very prolonged clinical history with repeated MRI.
authors.affiliation: Department of Neurosciences, University of Rome "La Sapienza", Rome, Italy.
authors.forename: C
authors.initials: C
authors.lastname: Fieschi
authors.forename: C
authors.initials: C
authors.lastname: Gasperini
authors.forename: G
authors.initials: G
authors.lastname: Ristori
authors.forename: S
authors.initials: S
authors.lastname: Bastianello
authors.forename: F
authors.initials: F
authors.lastname: Girmenia
authors.forename: V
authors.initials: V
authors.lastname: Leuzzi
authors.forename: C
authors.initials: C
authors.lastname: Buttinelli
authors.forename: C
authors.initials: C
authors.lastname: Pozzilli
authors.forename: M
authors.initials: M
authors.lastname: Rasura