Differential Diagnosis

The first requirement for a diagnosis of MS is that the presenting signs and symptoms be consistent with demyelinating disease.  

Differential Diagnosis Mnemonic

V

Vascular

Multiple lacunar infarcts; CADASIL; spinal arteriovenous malformation

I

Infectious

Lyme disease; syphilis; HIV myelopathy; PML; HTLV-1 myelopathy

T

Traumatic

Spondylitic myelopathy

A

Autoimmune

NMO; acute disseminated encephalomyelitis; CNS vasculitis; Behcet syndrome, sarcoidosis; SLE

M

Metabolic/Toxic

Central pontine myelinolysis; vitamin B12 deficiency; vitamin B6 deficiency; radiation; hypoxia

I

Idiopathic/Genetic

Spinocerebellar degeneration; Friedreich ataxia; Arnold-Chiari malformation; adrenoleukodystrophy; metachromatic dystrophy

N

Neoplastic

CNS lymphoma; glioma; paraneoplastic encephalomyelitis; metastatic cord compression

S

Psychiatric

Conversion disorder

The presenting symptoms in patients with MS can vary significantly. Click here to see a frequency table of presenting symptoms.