Findings that indicate a condition other than MS:
(1) presence of systemic symptoms (fever, night sweats, unintended weight loss, gastrointestinal symptoms)
(2) absence of neurological deficits over a period of time
(3) prominent neurological deficits early in the disease
(4) acute stroke-like event
(5) onset when the patient is > 60 years old
(6) CSF WBC count > 50 per µL
(7) CSF protein > 100 mg/dL
(8) increased neutrophils in the CSF
(9) decreased glucose in the CSF (hypoglycorrhachia)
(10) normal MRI scans of the brain over time
(11) lesions predominantly involving the grey matter
(12) sparing of the corpus collosum
(13) presence of a solitary closed-ring enhancing lesion
(14) presence of meningeal enhancement
(15) presence of a solitary lesion with prominent mass effect that increases over time
Findings that tend to favor a diagnosis other than MS:
(1) absence of oligoclonal bands in the CSF (seen in 5-10% of patients with MS)
Conditions to consider include:
(1) infectious disease (Lyme borreliosis, HIV encephalitis, PML, etc)
(2) vitamin B12 deficiency
(3) toxic leukoencephalopathy
(4) autoimmune disease (Behcet's, vasculitis of the CNS)
(5) antiphospholipid antibody syndrome
(6) neurosarcoidosis
(7) leukodystrophy
(8) mitochondrial disease
(9) CADASIL
(10) homocysteinuria
(11) hereditary cerebral amyloid angiopathies
(12) Fabry's disease
