Other Conditions to Rule Out - National Multiple Sclerosis Society

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Other Conditions to Rule Out

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Overview

The diagnoses listed below can cause neurologic symptoms that are similar to those caused by multiple sclerosis (MS). In order to confirm the diagnosis of MS, your doctor must be able to rule out other possible diagnoses that could explain the symptoms you are experiencing.

Some of these diagnoses are easy to rule out with a simple blood test (e.g. vitamin B12 deficiency), while others, such as sarcoidosis, may require a biopsy. Some are much rarer than others. It’s important to work with a physician who is familiar with these conditions in order to arrive at a correct diagnosis as quickly as possible — and begin the appropriate treatment — whether you have MS or not.

Infections of the central nervous system (CNS)

Inflammatory disorders of the CNS

  • Sjögren’s syndrome — A chronic autoimmune disease that  attacks the body’s moisture producing glands, causing dry eyes and mouth, generalized fatigue, joint pain and sometimes neurologic symptoms.
  • Vasculitis — An autoimmune disorder that attacks the blood vessels that supply the brain and spinal cord, producing  neurologic symptoms.
  • Systemic lupus erythematosusA chronic, inflammatory autoimmune disorder that can affect the skin, joints, kidneys, lungs, nervous system and other organs of the body.
  • Sarcoidosis — A chronic, probably autoimmune condition that produces  collections of inflammatory cells (granulomas) in the lungs, skin, lymph nodes, liver and central nervous system, commonly producing respiratory symptoms and, sometimes, neurologic symptoms.
  • Behçet’s disease — An autoimmune disease that damages blood vessels, particularly veins.  In addition to mouth sores, genital sores, inflammation inside of the eye and skin problems, Behcets can affect the white matter in the brain.

Genetic disorders

Brain Tumors

  • Metastases  — Cancer that has spread from its original location to another is considered metastatic. Some cancers — breast, lung, kidney and skin (melanoma) — are more likely to spread to the central nervous system and cause neurologic symptoms.
  • Lymphoma — A blood cancer involving rapid replication of abnormal T or B lymphocytes (types of white blood cells) that form tumors — which sometimes occurs in the central nervous system (CNS) or spreads to the brain from other locations.

Deficiencies

  • Copper deficiency — A relatively rare deficiency seen with excessive zinc intake or some types of stomach surgery, which can cause neurologic symptoms.
  • Vitamin B12 deficiency — A deficiency of this vitamin, which is critical to neurologic function, can occur because of dietary limitations or absorption problems and is a common cause of neurologic symptoms.

Structural damage in the brain or spinal cord​

  • Cervical spondylosis — A degeneration of the spine associated with normal aging that can press on the spinal cord and cause neurologic symptoms.
  • Herniated disc — A disc that acts as a cushion between the vertebrae (bones) of the spine can deteriorate with age – moving or slipping out of place (referred to as ‘herniated’). A herniated disc places pressure on the nerves in the area, producing neurologic symptoms.
  • Chiari’s malformation — An abnormality in the position of the cerebellum — a brain structure responsible for balance and coordination. When the cerebellum sits too low, it puts pressure on the spinal cord or brainstem, producing neurologic symptoms.

Other non-MS demyelinating disorders

  • Neuromyelitis optica (NMO) — A separate disease from MS that shares several clinical features. NMO most often causes visual changes in both eyes and symptoms caused by long lesions in the spinal cord.
  • Acute disseminated encephalomyelitis (ADEM) — A brief but intense attack of inflammation in the brain, spinal cord and occasionally the optic nerve that causes damage to myelin. Symptoms of ADEM come on quickly, often beginning with behavior changes.

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