Differential diagnosis of multiple sclerosis: The better explanations in clinical practice

A diagnosis of multiple sclerosis (MS) requires not only the demonstration of CNS lesions disseminated in time and space but also the active exclusion of alternative diagnoses.¹ This requirement for "no better explanation" represents a substantial challenge given the varied clinical manifestations of MS, and the absence of a diagnostic test that readily distinguishes MS from other disorders.² Textbooks and review articles often present long lists of diseases that should be considered in the differential diagnosis of suspected MS.^2,3 These include a diverse range of uncommon inflammatory and noninflammatory disorders that present with a relapsing or progressive course.³ MRI is a useful tool in identifying the so-called better explanations.⁴ Some conditions once included in the differential diagnosis of MS³ are easily excluded (e.g., stroke, compressive myelopathy), while certain MRI abnormalities may strongly point to an alternative diagnosis (e.g., neuromyelitis optica spectrum disorder [NMOSD], neurosarcoidosis, Susac syndrome).⁴ On the other hand, MRI also frequently detects nonspecific white matter lesions that can sometimes lead to misdiagnosis when symptoms and MRI abnormalities are misinterpreted as being due to MS.⁵

from Neurology recent issues http://bit.ly/2K7ITeh