A differential diagnosis of central nervous system demyelination: Beyond multiple sclerosis

Christopher Eckstein, Shiv Saidha, Michael Levy

Research output: Contribution to journalArticle

Abstract

Although multiple sclerosis (MS) is the most common demyelinating disorder of the central nervous system (CNS), it lacks any definitive diagnostic test. Instead, diagnosis of MS primarily depends upon clinical criteria, supported by abnormalities characteristic of MS on para-clinical investigations including magnetic resonance imaging of the brain and spine, in the absence of an alternative explanation for underlying neurologic symptoms. While many of the potential disorders that may mimic MS in routine clinical practice are either extremely rare, or associated with specific and characteristic distinguishing diagnostic features, some inflammatory demyelinating disorders of the CNS may be particularly challenging to distinguish from MS, especially during initial presentation. In particular, acute disseminated encephalomyelitis, neuromyelitis optica, and idiopathic transverse myelitis may closely resemble MS, impeding prompt and accurate diagnosis. In this review, we describe the clinical features, diagnosis, pathology, and treatment of these other CNS demyelinating disorders. In addition, we review relevant features of other CNS inflammatory disorders that may mimic MS, including Sjögren's syndrome, systemic lupus erythematosus, Behçet's disease, and primary CNS vasculitis.

Original languageEnglish (US)
Pages (from-to)801-816
Number of pages16
JournalJournal of Neurology
Volume259
Issue number5
DOIs
StatePublished - May 2012

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Demyelinating Diseases
Multiple Sclerosis
Differential Diagnosis
Central Nervous System
Central Nervous System Diseases
Transverse Myelitis
Acute Disseminated Encephalomyelitis
Central Nervous System Vasculitis
Neuromyelitis Optica
Neurologic Manifestations
Routine Diagnostic Tests
Systemic Lupus Erythematosus
Spine
Magnetic Resonance Imaging
Pathology
Brain

Keywords

  • Acute disseminated encephalomyelitis
  • Demyelination
  • Keywords Multiple sclerosis
  • Neuromyelitis optica
  • Transverse myelitis

ASJC Scopus subject areas

  • Clinical Neurology
  • Neurology

Cite this

A differential diagnosis of central nervous system demyelination : Beyond multiple sclerosis. / Eckstein, Christopher; Saidha, Shiv; Levy, Michael.

In: Journal of Neurology, Vol. 259, No. 5, 05.2012, p. 801-816.

Research output: Contribution to journalArticle

Eckstein, Christopher ; Saidha, Shiv ; Levy, Michael. / A differential diagnosis of central nervous system demyelination : Beyond multiple sclerosis. In: Journal of Neurology. 2012 ; Vol. 259, No. 5. pp. 801-816.
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