Differential diagnosis

Most structural conditions, such as cervical myelopathy or syringomyelia, which at one time formed a major part of the differential diagnosis, will be identified by MRI. Though brain scanning will generally reveal the periventricular and sub-cortical changes associated with MS, imaging of the spinal cord is essential in those patients presenting with primarily spinal symptomatology, particularly in late-onset progressive disease where the differential is wide.

Other systemic inflammatory conditions, such as the connective tissue disorders and sarcoid, need to be considered and a careful history to include both previous minor neurological symptoms (which have often been forgotten or overlooked) and systemic features (rash, joint disease etc) is required.

Where clinical or imaging findings are atypical or equivocal further investigations, such as lumbar puncture for oligoclonal bands in the spinal fluid and visual evoked potentials, are often undertaken to substantiate or exclude the diagnosis. Blood tests such as inflammatory markers, immunology and B12 and folate will generally be performed as part of the process of exclusion of other causes of CNS disease.

Last edited: 21/10/2003

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