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:
Acute Disseminated EncephaloMyelitis (ADEM) - also known as Post-Infectious Encephalitis
Cervical Spondylosis and many more.
Here is a table of how a few different central nervous system conditions show up differently in MRI scans:
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 |
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Author: Paul Jones
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