Differential diagnosis of multiple sclerosis is very broad in nature. About hundred conditions can imitate multiple sclerosis, this figure is rather an under-estimate. However, it is impractical and tedious to perform such differential diagnosis routinely to rule out multiple sclerosis. Instead, key features of each patient allow a rational consideration of relevant alternate diagnosis. Potential multiple sclerosis “mimics” can be easily distinguished from other patients as most relapsing onset patients have either optic neuritis or myelitic syndromes.
1. Monosymptomatic demyelination
It is a single attack of optic neuritis, horizontal myelitis or any other lesions limited to one anatomic localization at one point in time. It represents first incident of multiple sclerosis. It shares similar symptoms and covers a broad spectrum of other neurologic disorders. More than half of the cases have abnormal MRI, with other subclinical lesions in other parts of central nervous system. Time factor differentiates this disease from multiple sclerosis. Presence of another lesion after MRI done a month later will imply multiple sclerosis.
2. Schilder disease
It is the demyel...
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...d may be increased. Meningeal abnormalities are often seen in MRI. Skin, lung and lymph node biopsies are definitive.
15. Anterior ischemic optic neuropathy (AION)
It is the arrest of second cranial nerve because of vascular disorder, either vasculitic or artheroclerotic. Subacute or sudden monocular vision loss may resemble optic neuritis as in multiple sclerosis. The disease is commonly affecting elderly patients (more than 50 years) with lipid plaques risk factors. However, no other symptom of multiple sclerosis is seen. Normal cerebrospinal fluid and MRI scanning are evident.
16. Cogan syndrome
It is the disease of interstitial keratitis with deafness and vertigo attacks. Ataxic incidents may occasionally report. Abnormal MRI scans are of rare complaints. Deafness is very rare incidence in multiple sclerosis. Plus, cerebrospinal fluid readings are normal.
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