Multiple sclerosis (MS) looks different for each person, and many health conditions have symptoms that can mimic MS. Because no single test or symptom can confirm MS on its own, doctors often need to rule out other possible conditions before making a diagnosis.

Some infections, vascular (blood vessel) diseases, brain conditions, and vitamin deficiencies can cause symptoms similar to those of MS. Read on to learn more about conditions that may mimic MS.

Infectious Diseases

Several infections, especially viral illnesses, can cause neurological symptoms or trigger immune responses that cause MS-like symptoms. These include:

• Epstein-Barr virus (EBV) — This common herpes virus often occurs in childhood and is believed to play a role in the development of MS.
• Cytomegalovirus — Also a herpes virus, cytomegalovirus may contribute to changes in immune cells linked to more severe MS symptoms.
• Lyme disease — Caused by the bacteria Borrelia burgdorferi, Lyme disease can lead to symptoms that closely resemble MS.
• Progressive multifocal leukoencephalopathy — This rare neurological disorder destroys cells in the central nervous system (CNS) that produce myelin, the protective coating around nerves. Symptoms and findings on MRI scans can look like MS.
• Varicella zoster — This virus that causes chickenpox and shingles. Some studies suggest it may be linked to relapsing-remitting MS, the most common form of MS.

Researchers think that some viruses, like EBV and varicella zoster, may confuse the immune system so that it mistakenly attacks healthy neurons (nerve cells). Another theory is that these viruses increase inflammation by boosting levels of immune cells.

Can Shingles Be Mistaken for MS?

MyMSTeam members have discussed the link between shingles and MS and vaccination options for shingles. One member asked, “Is there a connection between MS and shingles outbreak?”

Shingles happens when nerves near the spinal cord or torso become inflamed. Some symptoms are similar to those of MS. For example, people with MS may have numbness or tingling, and shingles can cause burning or tingling sensations. Fatigue and vision problems are other common symptoms of both conditions.

There’s a vaccine for shingles, and it’s recommended by the Centers for Disease Control and Prevention (CDC) for some people with MS. Talk to your healthcare provider about whether the shingles vaccine might be a good option for you.

Vascular Diseases

Sometimes, an MS relapse can be mistaken for a stroke. A stroke occurs when a blood vessel in the brain gets blocked or bursts, damaging brain cells. Some studies suggest that people with MS may have a higher risk of stroke.

Vasculitis, also called angiitis, is a rare condition that causes inflammation in blood vessels. This swelling can damage these blood vessels and affect arteries or veins of any size.

Central nervous system vasculitis (CNSV) is an autoimmune condition that affects the brain and spinal cord, causing blood vessel walls to thicken and sometimes leading to tissue damage. CNSV can be hard to tell apart from MS because some types are more likely to occur in people with MS.

Neurological Autoimmune Diseases

Other autoimmune diseases can affect the CNS. Some of these neurological conditions can be mistaken for MS.

Acute Disseminated Encephalomyelitis

Acute disseminated encephalomyelitis is a brief but widespread swelling in the brain, spinal cord, and sometimes the optic nerves (in the eye). Common symptoms include vision loss, trouble walking, problems with coordination, and numbness or tingling — all of which may also appear in MS.

Chronic Inflammatory Demyelinating Polyradiculoneuropathy

Chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) is a rare autoimmune disorder that affects nerves outside the brain and spinal cord. CIDP can cause muscle weakness and numbness in the arms and legs. Like MS, CIDP involves damage to myelin, which can lead to worsening symptoms over time and affect movement and coordination.

CIDP is also related to Guillain-Barré syndrome, which — like MS — can cause numbness, leg weakness, and breathing problems. However, CIDP typically lasts longer than Guillain-Barré syndrome.

Neuromyelitis Optica

Neuromyelitis optica spectrum disorder (NMOSD) typically affects the optic nerves and spinal cord. Like MS, NMOSD is an autoimmune disease that causes inflammation in the CNS. However, neuromyelitis optica usually involves a specific antibody that confirms the diagnosis. MRI scans in people with NMOSD may show unique patterns of damage. One kind of lesion has been linked to unusual symptoms like vomiting or hiccups.

Posterior Reversible Encephalopathy Syndrome

Posterior reversible encephalopathy syndrome is a neurological condition that can result from high blood pressure, preeclampsia, some autoimmune diseases, and severe infections. Symptoms include headaches, seizures, confusion, and visual loss. This disorder is rare in people with MS, but it has been linked to corticosteroid medications taken for MS flare-ups.

Susac Syndrome

Susac syndrome is a rare disorder involving small vessels in the brain, eyes, and ears. Symptoms include vision problems, confusion, or hearing loss, depending on which areas are affected. MRI findings in people with Susac syndrome can sometimes look like MS.

Leukoencephalopathies

Leukoencephalopathies are a group of related disorders that affect the brain’s white matter— the deep areas that contain axons (nerve fibers) covered by myelin. Many of these conditions can mimic MS, especially on MRI scans. Types of leukoencephalopathies include these genetic conditions:

• Alexander disease — Causes the loss of myelin in the brain, leading to white matter damage
• Adrenoleukodystrophy — Affects the brain’s white matter and can lead to neurological symptoms
• Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy — Involves small blood vessels in the brain and can increase stroke risk
• Metachromatic leukodystrophy — Causes a buildup of fatty substances in the brain and spinal cord that damages myelin around nerve cells, leading to vision and coordination problems that may resemble MS

Vitamin B12 Deficiency

Vitamin B12 helps make red blood cells and supports healthy nerve function. Vitamin B12 deficiency is uncommon but can happen in people who follow vegetarian or vegan diets or who have digestive problems that affect nutrient absorption. Because vitamin B12 is important for neurologic function, low levels can cause numbness and tingling — common symptoms of MS.

Join the Conversation

On MyMSTeam, people share their experiences with multiple sclerosis, get advice, and find support from others who understand.

Are you living with multiple sclerosis? Did any of these conditions come up as possibilities on your path to an MS diagnosis? Let others know in the comments below.