Ruling Out Other Conditions

An important part of the diagnostic criteria for MS requires that the doctor rule out other possible causes of MS-like symptoms and/or damage to the CNS. In MS, most symptoms occur because of demyelination or damage to the myelin sheath that covers and protects nerve fibers.

What conditions are confused with MS?

Interestingly, the most common diseases confused with MS are not inflammatory autoimmune diseases. Instead, mental health conditions such as depression and anxiety which involve fluctuating neurologic symptoms, including fatigue, dizziness and problems with balance, and trouble concentrating, are most often mistaken for MS. Other conditions commonly mistaken for MS include migraine and stroke.

What diseases share clinical features with MS?

While MS is the most common cause of demyelination, other health conditions can cause similar nerve damage, including viral infections, severe vitamin B12 deficiency, and other autoimmune diseases. Many of the conditions, involving nerve damage which may resemble MS lesions on an MRI scan, are somewhat rare. The table below lists some of these conditions.

Rare Conditions That Involve MS-Like Nerve Damage

Disease or condition
Inflammatory autoimmune diseases
  • Sjorgren’s disease
  • Lupus
  • Acute disseminated encephalomyelitis (ADEM)
  • Scleroderma
  • Neuromyelitis optica (NMO)
Vascular disease
  • CNS vasculitis
  • Susac’s disease
Infectious disease
  • Lyme disease
  • Syphilis
  • Human immunodeficiency virus (HIV)
  • Human T-lymphotropic virus Type I and 2
Degenerative diseases /disease of metabolism
  • Central pontine myelinolysis (CPM)
  • Celiac disease (sprue)
  • Amyotrophic lateral sclerosis (ALS)
Genetic diseases
  • Adrenoleukodystrophy syndromes
  • Spinocerebellar ataxias (SCA)
  • Leber’s hereditary optic neuropathy (LHON)
  • CNS lymphoma
  • Paraneoplastic syndromes

Adapted from Rolak LA. Diagnosis of multiple sclerosis. In Giesser BS, ed. Primer on Multiple Sclerosis. New York, NY: Oxford University Press; 2011:81-90.

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Written by: Jonathan Simmons | Last reviewed: May 2015.