Multiple sclerosis differential diagnosis: Difference between revisions
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* '''systemic lupus erythematosus:''' Systemic lupus erythromatosus can cause neurological manifestations such as seizures, movement disorders, transverse myelitis, cranial and peripheral neuropathies and optic nerve involvement. In the brain MRI of SLE patients there are evidences of atrophy and subcortical white matter lesions. SLE is diagnosed based on systemic manifestations, present of oligoclonal bands and IgG in CSF and high titer of antinuclear antibodies.<ref name="pmid7854544">{{cite journal |vauthors=Barned S, Goodman AD, Mattson DH |title=Frequency of anti-nuclear antibodies in multiple sclerosis |journal=Neurology |volume=45 |issue=2 |pages=384–5 |year=1995 |pmid=7854544 |doi= |url=}}</ref> | * '''systemic lupus erythematosus:''' Systemic lupus erythromatosus can cause neurological manifestations such as seizures, movement disorders, transverse myelitis, cranial and peripheral neuropathies and optic nerve involvement. In the brain MRI of SLE patients there are evidences of atrophy and subcortical white matter lesions. SLE is diagnosed based on systemic manifestations, present of oligoclonal bands and IgG in CSF and high titer of antinuclear antibodies.<ref name="pmid7854544">{{cite journal |vauthors=Barned S, Goodman AD, Mattson DH |title=Frequency of anti-nuclear antibodies in multiple sclerosis |journal=Neurology |volume=45 |issue=2 |pages=384–5 |year=1995 |pmid=7854544 |doi= |url=}}</ref> | ||
* '''Sjögren’s syndrome:''' Sjogren disease can cause neurological manifestations including cerebral vasculitis, myopathy, transvers myelitis and acute optic neuropathy. There are evidence of oligoclonal band and increased IgG in CSF and white matter lesions in MRI. Sicca syndrome, rheumatic manifestation and high titers of ANA,SSRo and SS-La will confirm the diagnosis.<ref name="pmid3946977">{{cite journal |vauthors=Alexander EL, Malinow K, Lejewski JE, Jerdan MS, Provost TT, Alexander GE |title=Primary Sjögren's syndrome with central nervous system disease mimicking multiple sclerosis |journal=Ann. Intern. Med. |volume=104 |issue=3 |pages=323–30 |year=1986 |pmid=3946977 |doi= |url=}}</ref> | * '''Sjögren’s syndrome:''' Sjogren disease can cause neurological manifestations including cerebral vasculitis, myopathy, transvers myelitis and acute optic neuropathy. There are evidence of oligoclonal band and increased IgG in CSF and white matter lesions in MRI. Sicca syndrome, rheumatic manifestation and high titers of ANA,SSRo and SS-La will confirm the diagnosis.<ref name="pmid3946977">{{cite journal |vauthors=Alexander EL, Malinow K, Lejewski JE, Jerdan MS, Provost TT, Alexander GE |title=Primary Sjögren's syndrome with central nervous system disease mimicking multiple sclerosis |journal=Ann. Intern. Med. |volume=104 |issue=3 |pages=323–30 |year=1986 |pmid=3946977 |doi= |url=}}</ref> | ||
* '''Vasculitis:''' Wegner’s granulomatosis and polyarteritis nodosa are sometimes categorized as a differential diagnosis of MS, but the most common vasculitis which can mimic MS is isolated angitis of the central nervous system (IACNS).<ref name="pmid1516217">{{cite journal |vauthors=Calabrese LH, Furlan AJ, Gragg LA, Ropos TJ |title=Primary angiitis of the central nervous system: diagnostic criteria and clinical approach |journal=Cleve Clin J Med |volume=59 |issue=3 |pages=293–306 |year=1992 |pmid=1516217 |doi= |url=}}</ref> IACNS is an inflammatory disease with an unknown cause. It affects small and medium sized arteries in the brain parenchyma and meninges. Neurological manifestation of this disease is headache, personality change, paresis, seizures, cranial neuropathy and intracerebral /subarachnoid hemorrhages.<ref name="pmid9214418">{{cite journal |vauthors=Calabrese LH, Duna GF, Lie JT |title=Vasculitis in the central nervous system |journal=Arthritis Rheum. |volume=40 |issue=7 |pages=1189–201 |year=1997 |pmid=9214418 |doi=10.1002/1529-0131(199707)40:7<1189::AID-ART2>3.0.CO;2-4 |url=}}</ref> There are monoclonal bands and increased protein and lymphocytic pleocytosis and IgG levels in the CSF of this patients. MRI may show patchy or diffuse increased signal in periventricular and subcortical white matter. | * '''Vasculitis:''' Wegner’s granulomatosis and polyarteritis nodosa are sometimes categorized as a differential diagnosis of MS, but the most common vasculitis which can mimic MS is isolated angitis of the central nervous system (IACNS).<ref name="pmid1516217">{{cite journal |vauthors=Calabrese LH, Furlan AJ, Gragg LA, Ropos TJ |title=Primary angiitis of the central nervous system: diagnostic criteria and clinical approach |journal=Cleve Clin J Med |volume=59 |issue=3 |pages=293–306 |year=1992 |pmid=1516217 |doi= |url=}}</ref> IACNS is an inflammatory disease with an unknown cause. It affects small and medium sized arteries in the brain parenchyma and meninges. Neurological manifestation of this disease is headache, personality change, paresis, seizures, cranial neuropathy and intracerebral /subarachnoid hemorrhages.<ref name="pmid9214418">{{cite journal |vauthors=Calabrese LH, Duna GF, Lie JT |title=Vasculitis in the central nervous system |journal=Arthritis Rheum. |volume=40 |issue=7 |pages=1189–201 |year=1997 |pmid=9214418 |doi=10.1002/1529-0131(199707)40:7<1189::AID-ART2>3.0.CO;2-4 |url=}}</ref> There are monoclonal bands and increased protein and lymphocytic pleocytosis and IgG levels in the CSF of this patients. MRI may show patchy or diffuse increased signal in periventricular and subcortical white matter.<ref name="pmid9855557">{{cite journal |vauthors=Berger JR, Wei T, Wilson D |title=Idiopathic granulomatous angiitis of the CNS manifesting as diffuse white matter disease |journal=Neurology |volume=51 |issue=6 |pages=1774–5 |year=1998 |pmid=9855557 |doi= |url=}}</ref> | ||
* '''Behçet’s disease:''' | * '''Behçet’s disease:''' | ||
* '''sarcoidosis:''' | * '''sarcoidosis:''' | ||
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
- Overview
Differentiating multiple sclerosis from other diseases
Multiple sclerosis must be differentiated from other diseases that can mimic this disease clinically or radiologically such as:
Inflammatory/autoimmune conditions:
- systemic lupus erythematosus: Systemic lupus erythromatosus can cause neurological manifestations such as seizures, movement disorders, transverse myelitis, cranial and peripheral neuropathies and optic nerve involvement. In the brain MRI of SLE patients there are evidences of atrophy and subcortical white matter lesions. SLE is diagnosed based on systemic manifestations, present of oligoclonal bands and IgG in CSF and high titer of antinuclear antibodies.[1]
- Sjögren’s syndrome: Sjogren disease can cause neurological manifestations including cerebral vasculitis, myopathy, transvers myelitis and acute optic neuropathy. There are evidence of oligoclonal band and increased IgG in CSF and white matter lesions in MRI. Sicca syndrome, rheumatic manifestation and high titers of ANA,SSRo and SS-La will confirm the diagnosis.[2]
- Vasculitis: Wegner’s granulomatosis and polyarteritis nodosa are sometimes categorized as a differential diagnosis of MS, but the most common vasculitis which can mimic MS is isolated angitis of the central nervous system (IACNS).[3] IACNS is an inflammatory disease with an unknown cause. It affects small and medium sized arteries in the brain parenchyma and meninges. Neurological manifestation of this disease is headache, personality change, paresis, seizures, cranial neuropathy and intracerebral /subarachnoid hemorrhages.[4] There are monoclonal bands and increased protein and lymphocytic pleocytosis and IgG levels in the CSF of this patients. MRI may show patchy or diffuse increased signal in periventricular and subcortical white matter.[5]
- Behçet’s disease:
- sarcoidosis:
- Antiphospholipid (Hughes) Syndrome
- Primary Angiitis of the CNS
- Susac Syndrome
Infections:
- Lyme disease:
- syphilis:
- Progressive multifocal leukoencephalopathy:
- HTLV-1 infection:
- Herpes zoster:
Metabolic and genetic disorders:
- Vitamin B12 deficiency:
- Lysosomal disorders:
- Adrenoleukodystrophy:
- Mitochondrial disorders:
- Clinically defined genetic disorders:
CNS lymphoma
spinal diseases
References
- ↑ Barned S, Goodman AD, Mattson DH (1995). "Frequency of anti-nuclear antibodies in multiple sclerosis". Neurology. 45 (2): 384–5. PMID 7854544.
- ↑ Alexander EL, Malinow K, Lejewski JE, Jerdan MS, Provost TT, Alexander GE (1986). "Primary Sjögren's syndrome with central nervous system disease mimicking multiple sclerosis". Ann. Intern. Med. 104 (3): 323–30. PMID 3946977.
- ↑ Calabrese LH, Furlan AJ, Gragg LA, Ropos TJ (1992). "Primary angiitis of the central nervous system: diagnostic criteria and clinical approach". Cleve Clin J Med. 59 (3): 293–306. PMID 1516217.
- ↑ Calabrese LH, Duna GF, Lie JT (1997). "Vasculitis in the central nervous system". Arthritis Rheum. 40 (7): 1189–201. doi:10.1002/1529-0131(199707)40:7<1189::AID-ART2>3.0.CO;2-4. PMID 9214418.
- ↑ Berger JR, Wei T, Wilson D (1998). "Idiopathic granulomatous angiitis of the CNS manifesting as diffuse white matter disease". Neurology. 51 (6): 1774–5. PMID 9855557.