Clinical cases

Magd Zakaria: Recognising Typical and Atypical Presentations in Multiple Sclerosis

Magd Zakaria reviews visual, spinal cord and brainstem presentations in Multiple Sclerosis and highlights key diagnostic red flags for NMOSD and MOGAD.

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Magd Zakaria discusses the clinical features that can help distinguish typical presentations of Multiple Sclerosis from red flags suggestive of alternative demyelinating disorders.

Visual, spinal cord and brainstem syndromes are among the most common clinical presentations at the onset of Multiple Sclerosis (MS), often occurring as a clinically isolated syndrome (CIS).

In this interview, Magd Zakaria reviews the characteristic features of these presentations and highlights findings that are atypical for MS. He explains how symptom severity, bilateral involvement, treatment response and Magnetic Resonance Imaging (MRI) characteristics can support the differential diagnosis between MS, Neuromyelitis Optica Spectrum Disorder (NMOSD) and Myelin Oligodendrocyte Glycoprotein Antibody Disease (MOGAD).

Key points discussed include:

Key points discussed include:
The three most common clinical presentations at the onset of MS.
Typical features and diagnostic red flags in patients presenting with visual impairment.
How the severity and laterality of optic involvement may help distinguish MS from NMOSD and MOGAD.
Clinical and MRI characteristics of spinal cord involvement in MS.
Typical and atypical brainstem presentations.
Why clinical assessment remains essential alongside advanced diagnostic technologies.

Which clinical features can help distinguish typical Multiple Sclerosis presentations from NMOSD, MOGAD and other differential diagnoses?

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Key messages from Magd Zakaria

Visual, spinal cord and brainstem syndromes are common presentations at the onset of Multiple Sclerosis (MS).
Severe or bilateral visual loss, or limited response to corticosteroids, may suggest an alternative diagnosis.
MS spinal cord involvement usually presents as partial myelitis with short-segment, lateral or posterolateral lesions.
Longitudinally extensive lesions, cord swelling and severe transverse myelitis are atypical for MS and may indicate Neuromyelitis Optica Spectrum Disorder (NMOSD) or Myelin Oligodendrocyte Glycoprotein Antibody Disease (MOGAD).
Clinical assessment remains essential, even as imaging and diagnostic technologies continue to advance.