Table 1.

Alternative Diagnoses to MS and “Rule Out” Diagnostic Tests.^a

Disease Category	Examples
Infectious	Syphilis, Lyme disease, HIV
Inflammatory	Sarcoidosis
Other autoimmune	Systemic lupus erythematosus (SLE), Sjogren syndrome, Behçet disease
Other MS mimics	Neuromyelitis optica, acute disseminated encephalomyelitis
Metabolic	Vitamin B12 deficiency, nitrous oxide toxicity, copper deficiency
Genetic	Leukodystrophy, mitochondrial disorder
Vascular	CNS vasculitis, small vessel ischemic disease
Anatomical or structural	Compressive lesions
Neoplastic or paraneoplastic	Lymphoma, glioma
Special considerations with the presentation of an isolated optic neuritis: glaucoma, sarcoidosis, compressive lesions, neuromyelitis optica, other autoimmune diseases (SLE, Sjogren, Behçet, antiphospholipid antibody syndrome), infection (West Nile virus, HIV, varicella zoster virus, cryptococcus, toxoplasmosis, syphilis, histoplasmosis, Lyme disease), B12 deficiency, retinal artery occlusion, retinal detachment, ischemic optic neuropathy, infiltrative optic neuropathy, hereditary optic neuropathy, recurrent idiopathic optic neuritis.
Special considerations with the presentation of an isolated myelopathy: compressive lesions, neoplasms, neuromyelitis optica, other autoimmune (SLE, Sjogren), sarcoidosis, infections (syphilis, Lyme disease, viral, TB, mycoplasma, HIV), ischemia/infarction, epidural abscess, spinal epidural hematoma, spinal arteriorvenous malformation, dural venous fistula, cervical stenosis, syrinx, toxic/metabolic (B12 deficiency, nitrous oxide toxicity, copper deficiency), hereditary spastic paraparesis, adrenomyeloneuropathy, idiopathic transverse myelitis.
Special considerations with the presentation of an isolated ataxia or brainstem syndrome: spinocerebellar ataxias, Wernicke syndrome, vitamin E deficiency, viral or postinfectious encephalitis, neoplasm, cerebrovascular disease, cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL), myasthenia gravis.

Abbreviations: MS, multiple sclerosis; TB, tuberculosis.

^a Produced with guidance from Rinker and Cross.¹⁷