differential diagnosis - multiple sclerosis encyclopaedia

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Differential Diagnosis

A differential diagnosis for a disease is another disease that has clinical or other similarities with it. Before making a firm diagnosis for any disease, it is important to rule out the differential diagnoses.

Because there is no specific test for multiple sclerosis, diagnosing it relies on the old Sherlock Holmes maxim that when you have ruled out all the possible alternatives, whatever remains, however improbable, must be the truth. Since there are so many potential symptoms associated with MS, there are a large number conditions that clinically resemble it in one way or another. Thus there are a large number of diffential diagnoses for it.

The differential diagnoses can be ruled out by blood tests, MRI scans, CT-scans, spinal taps etc.

Here is a list of some of the differential diagnoses for multiple sclerosis (in no particular order) - some of these are less severe than MS and some are more so, many are very rare:

Here is a table of how a few different central nervous system conditions show up differently in MRI scans:
MRI White Matter Abnormalities
Condition MRI Features

Multiple Sclerosis Multifocal, asymmetrical, periventricular lesions

ADEM Can be identical to MS. Symmetrical cerebral, basal ganglia or cerebral lesions in some

Ageing Usually less extensive than MS. Discrete lesions. Little posteria fossa involvement

Behcet's syndrome Prominent brain stem involvement

Cerebrovascular involvement Large lesions of arterial territories involving cortex as well as small lesions. Smooth periventricular lesions

Decompression sickness Focal sub-cortical lesions? Any difference from healthy controls

Fat embolism High signal lesions on T1-weighted images, high or low signal on T2-weighted

HIV encephalitis Patchy or punctate white matter lesions, commonly involving basal ganglia. Diffuse pattern in AIDS dementia complex

HTLV-1 associated myelopathy Usually few supratentorial lesions only

Hydrocephalus Diffuse smooth periventricular, high signal

Irradiation Diffuse periventricular and sub-cortical lesions

Leucodystrophies Various patterns of extensive symmetrical white matter abnormalities; atrophy

Migraine A few more discrete lesions than age-matched controls

Mitochondrial encephalopathy Diffuse abnormalities as well as stroke-like lesions

Motor neuron disease Symmetrical high signal involving pyramidal tracts, especially internal capsules

Neurosarcoidosis Can be identical to MS but also large parenchymal lesions, prominent basal involvement and diffuse menigeal enhancement

Phenylketonuria Periventricular and sub-cortical changes

Progressive multifocal leucoencephalopathy Large focal lesions

Subacute sclerosing panencephalitis Few scattered white matter lesions

Systemic lupus erythmatosus Many sub-cortical lesions; lesions involving arterial territories

Trauma Variable

**MRI White Matter Abnormalities**
Condition	MRI Features
Multiple Sclerosis	Multifocal, asymmetrical, periventricular lesions
ADEM	Can be identical to MS. Symmetrical cerebral, basal ganglia or cerebral lesions in some
Ageing	Usually less extensive than MS. Discrete lesions. Little posteria fossa involvement
Behcet's syndrome	Prominent brain stem involvement
Cerebrovascular involvement	Large lesions of arterial territories involving cortex as well as small lesions. Smooth periventricular lesions
Decompression sickness	Focal sub-cortical lesions? Any difference from healthy controls
Fat embolism	High signal lesions on T1-weighted images, high or low signal on T2-weighted
HIV encephalitis	Patchy or punctate white matter lesions, commonly involving basal ganglia. Diffuse pattern in AIDS dementia complex
HTLV-1 associated myelopathy	Usually few supratentorial lesions only
Hydrocephalus	Diffuse smooth periventricular, high signal
Irradiation	Diffuse periventricular and sub-cortical lesions
Leucodystrophies	Various patterns of extensive symmetrical white matter abnormalities; atrophy
Migraine	A few more discrete lesions than age-matched controls
Mitochondrial encephalopathy	Diffuse abnormalities as well as stroke-like lesions
Motor neuron disease	Symmetrical high signal involving pyramidal tracts, especially internal capsules
Neurosarcoidosis	Can be identical to MS but also large parenchymal lesions, prominent basal involvement and diffuse menigeal enhancement
Phenylketonuria	Periventricular and sub-cortical changes
Progressive multifocal leucoencephalopathy	Large focal lesions
Subacute sclerosing panencephalitis	Few scattered white matter lesions
Systemic lupus erythmatosus	Many sub-cortical lesions; lesions involving arterial territories
Trauma	Variable

Differential Diagnosis links:
Multiple Sclerosis: Differential Diagnosis
Multiple Sclerosis - NeuroHaven

MS Glossary
All About Multiple Sclerosis