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Diseases That Mimic MS: Your Guide

Posted on March 25, 2021
Medically reviewed by
Amit M. Shelat, D.O.
Article written by
Brooke Dulka, Ph.D.

Diagnosing multiple sclerosis (MS) can be difficult, in part because so many diseases mimic it. Multiple sclerosis is an autoimmune disease in which the conductive fat (myelin) that covers nerve fibers is eroded away, largely by inflammation. This process is called demyelination. Demyelination interrupts communication within the central nervous system (the spinal cord and brain), leading to the symptoms of MS.

However, other diseases work similarly in the body and can mimic multiple sclerosis. These include neurological autoimmune diseases, infectious diseases, and others. Working with a health care provider who is familiar with these conditions can help you receive the correct diagnosis.

Neurological Autoimmune Diseases

There are neurological autoimmune diseases other than MS in which the body attacks its own central nervous system. Some of these diseases may cause symptoms found in MS.

Acute Disseminated Encephalomyelitis

Acute disseminated encephalomyelitis is a brief but widespread attack of inflammation in the brain and spinal cord. Fatigue and physical impairments characterize both multiple sclerosis and acute disseminated encephalomyelitis, particularly in children.

Chronic Idiopathic Demyelinating Polyradiculoneuropathy

Chronic idiopathic demyelinating polyradiculoneuropathy is a rare neurological and autoimmune disorder in which inflammation causes nerve damage in the nerve roots and peripheral nerves. Destruction of myelin also occurs, as with MS. Symptoms include muscle weakness and impaired motor function, generally affecting both sides of the body.

Despite its shared features with multiple sclerosis, it does differ in some specific inflammatory biomarkers found within cerebrospinal fluid. The acute form of this condition is called acute inflammatory demyelinating polyradiculoneuropathy and it also falls under the umbrella of Guillain-Barre syndrome. This condition can also mimic the symptoms of MS or an MS exacerbation.

Neuromyelitis Optica

Neuromyelitis optica is a nervous system disorder that primarily affects the optic nerves and the spinal cord. Neuromyletis optica and multiple sclerosis are both autoimmune demyelinating diseases of the central nervous system, but they do have distinct symptoms and responses in the body.

Posterior Reversible Encephalopathy Syndrome

Posterior reversible encephalopathy syndrome mainly affects white brain matter, and it can result from high blood pressure, kidney failure, severe infections, certain medications, some autoimmune diseases, and pre-eclampsia. Symptoms include headaches, seizures, altered mental status, and visual loss. This disorder can both mimic and occur alongside multiple sclerosis.

Susac Syndrome

Susac syndrome describes immune-mediated lesions of the vascular system, typically involving small vessels in the brain, eye, and ear. In Susac syndrome, MRI findings can be mistakenly identified as demyelinating lesions like those seen in MS.

Infectious Diseases

Several infectious diseases may be mistaken for multiple sclerosis because of how they attack the central nervous system.

Epstein-Barr Virus

Epstein-Barr virus is a form of herpes that results in progressive immunodeficiency. In fact, this virus has been associated with a higher risk of multiple sclerosis and may even play a causal role in progression to MS.

Cytomegalovirus

Cytomegalovirus is another form of herpes that mimics multiple sclerosis. This virus may also contribute to MS development.

Lyme Disease

Lyme disease is an infection caused by bacteria called Borrelia burgdorferi. Lyme disease symptoms can mimic signs of multiple sclerosis. People with multiple sclerosis also tend to have the antibodies in their blood for Borrelia (which means that they previously had Lyme disease), suggesting that MS and Lyme disease may be associated.

Progressive Multifocal Leukoencephalopathy

Progressive multifocal leukoencephalopathy (PML) is also a neurological disorder that causes infection in the white matter of the brain, thus mimicking multiple sclerosis. In this case, neurodegeneration is caused by a virus known as the John Cunningham or JC virus.

Varicella Zoster Virus

Varicella zoster virus (which causes chicken pox and shingles) can mimic MS. It has also been associated with increased risk of relapsing remitting multiple sclerosis.

Leukoencephalopathies

Like PML, many types of leukoencephalopathies mimic multiple sclerosis. This classification of diseases all involve damage to the white matter (the myelinated nerve cords) in the brain.

Alexander’s Disease

Alexander’s disease is a rare genetic disorder that demyelinates the brain. It may cause clumsiness, trouble speaking (dysarthria), or trouble swallowing (dysphagia).

Adrenoleukodystrophy

Adrenoleukodystrophy is another genetic disorder that is linked to brain demyelination.

Cerebral Autosomal Dominant Idiopathic Leukoencephalopathy

A vascular disease, cerebral autosomal dominant idiopathic leukoencephalopathy is characterized by small blood vessels that ultimately cause brain damage and progressive neurological symptoms.

Metachromatic Leukodystrophy

Metachromatic leukodystrophy is a progressive metabolic disease characterized by demyelination of the central nervous system.

Other Conditions

Other mimics of multiple sclerosis include vasculitis and vitamin B12 deficiency. Vasculitis involves inflammation of the blood vessels, including those that supply the central nervous system. Vitamin B12 deficiency results in some symptoms similar to multiple sclerosis symptoms, as the vitamin is essential for neurologic function.

Talk With Others Who Understand

MyMSTeam is the social network for people with multiple sclerosis and their loved ones. On MyMSTeam, more than 164,000 members come together to ask questions, give advice, and share their stories with others who understand life with multiple sclerosis.

Are you living with multiple sclerosis? Did any of these conditions come up as possibilities on your path to diagnosis? Share your experience in the comments below, or start a conversation by posting on MyMSTeam.

References
  1. Inflammation, Demyelination, and Degeneration — Recent Insights From MS Pathology — Biochimica et Biophysica Acta (BBA) — Molecular Basis of Disease
  2. What Can Mimic Multiple Sclerosis? — Seminars in Ultrasound, CT, and MRI
  3. Fatigue and Physical Functioning in Children With Multiple Sclerosis and Acute Disseminated Encephalomyelitis — Multiple Sclerosis Journal
  4. Cerebrospinal Fluid Cytokine Expression Profile in Multiple Sclerosis and Chronic Inflammatory Demyelinating Polyneuropathy — Immunological Investigations
  5. Neurodegeneration in Multiple Sclerosis and Neuromyelitis Optica — Journal of Neurology, Neurosurgery & Psychiatry
  6. Posterior Reversible Encephalopathy Syndrome (PRES) — Oxford Medical Case Reports
  7. Posterior Reversible Encephalopathy Syndrome, Multiple Sclerosis, and Interferon Therapy: Association, Co-incidence or Convoluted Interplay? — Multiple Sclerosis and Related Disorders
  8. Two Cases of Susac Syndrome Mimicking Multiple Sclerosis — Neurology
  9. About Epstein-Barr Virus (EBV) — Centers for Disease Control and Prevention
  10. Systematic Review and Meta-analysis of the Association Between Epstein–Barr Virus, Multiple Sclerosis, and Other Risk Factors — Multiple Sclerosis Journal
  11. Cytomegalovirus: A Culprit or Protector in Multiple Sclerosis? — Trends in Molecular Medicine
  12. Lyme Borreliosis and Multiple Sclerosis: Any Connection? A Seroepidemic Study — Annals of Agricultural and Environmental Medicine: AAEM
  13. Progressive Multifocal Leukoencephalopathy Associated with Isolated CD8+ T-Lymphocyte Deficiency Mimicking Tumefactive MS — Journal of Neurovirology
  14. The High Prevalence of the Varicella Zoster Virus in Patients With Relapsing-Remitting Multiple Sclerosis: A Case-Control Study in the North of Iran — Jundishapur Journal of Microbiology
  15. A Novel Mutation in the Adult-Onset Alexander’s Disease GFAP Gene — Case Reports in Medicine
  16. Role of NOTCH3 Mutations in the Cerebral Small Vessel Disease Cerebral Autosomal Dominant Arteriopathy With Subcortical Infarcts and Leukoencephalopathy — Stroke
  17. Clinical Symptoms of Adult Metachromatic Leukodystrophy and Arylsulfatase A Pseudodeficiency — Archives of Neurology
  18. Inflammatory Vasculitis in Multiple Sclerosis — Journal of the Neurological Sciences
  19. Other Conditions To Rule Out — National Multiple Sclerosis Society
  20. Chronic Inflammatory Demyelinating Polyneuropathy — National Organization of Rare Disorders
All updates must be accompanied by text or a picture.
Amit M. Shelat, D.O. is a fellow of the American Academy of Neurology and the American College of Physicians. Review provided by VeriMed Healthcare Network. Learn more about him here.
Brooke Dulka, Ph.D. is a freelance science writer and editor. She received her doctoral training in biological psychology at the University of Tennessee. Learn more about her here.

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