Some MyMSTeam members say they received a multiple sclerosis (MS) diagnosis within weeks or months of developing noticeable symptoms. Others have gone years before receiving an official diagnosis.

“I’ve been under investigation for at least one year now. I’m feeling devastated because I believe I have several lesions and a long list of symptoms that match perfectly with MS,” wrote one member. “My healthcare team isn’t convinced, and I’m not sure what to do next.” (Lesions are areas of damage in the brain, spinal cord, or optic nerves that may be seen on MRI scans in MS.)

In this article, you’ll learn why an MS diagnosis can take time and why your doctor may consider other conditions that can cause similar symptoms. You’ll also learn about common next steps in your health journey and what to discuss with your doctor.

🗳️ If your MS tests were negative or inconclusive, what helps you most at doctor’s appointments?

A list of your symptoms or questions

Notes or tracking (journal, app, photos)

A support person (or someone on the phone)

It depends/Something else

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Why Diagnosing MS Is Challenging

Diagnosing MS isn’t always straightforward. Health experts haven’t identified one symptom, test, or scan finding that can diagnose MS on its own.

The McDonald diagnostic criteria are guidelines doctors use to help diagnose MS. The 2024 revisions include MRI findings in the brain, spinal cord, and optic nerve, along with certain CSF biomarkers, to help identify MS more quickly and accurately.

Doctors may also order additional exams, including blood tests and evoked potential tests, which measure how quickly and accurately nerves respond to stimulation.

Still, MS testing can sometimes return normal or inconclusive results, leading to additional exams. For example, not everyone has typical MS symptoms, and some people may not show abnormalities during CSF analysis. CSF analysis is often done after a lumbar puncture, also called a spinal tap, in which a doctor uses a needle to collect a small sample of fluid from around the spinal cord.

“I have brain lesions, but some tests have come back inconclusive. I’m in limbo as I wait to see my specialist for next steps.”

— A MyMSTeam member

Many other diseases can also cause abnormalities on an MRI. Rarely, someone with MS may have a normal MRI result.

Unfortunately, some MyMSTeam members report undergoing lengthy testing while doctors gather the information they need. “I have brain lesions, but some tests have come back inconclusive. I’m in limbo as I wait to see my specialist for next steps,” wrote one MyMSTeam member experiencing MS diagnosis challenges.

Other Diagnoses Similar to MS

Learning about alternative conditions can help you and your doctor work toward the right diagnosis. Some MS mimics may be easy to rule out, while others might need additional monitoring.

Below are some common alternative diagnoses your care team may explore, along with ways doctors may tell them apart from MS.

Migraine

Migraine is a condition that can cause moderate to severe, often one-sided headaches lasting hours or days. Research suggests it’s one of the most common conditions mistaken for MS, although about 31 percent of people with MS have both.

MS and migraine have overlapping symptoms, including headaches, fatigue, and mood changes. They can both be affected by stress and can also show similar-looking changes on an MRI.

However, there are a few main differences between the two conditions:

• Central vein sign — MS lesions often have a small vein running through their center, which may look like a small dot or thin line on certain MRI scans. Lesions associated with migraine usually do not.
• Symptom pattern — Migraine and associated symptoms often follow a pattern with consistent triggers, but MS-related symptoms can be more unpredictable.

Stroke

A stroke happens when blood flow to part of the brain is blocked or when a blood vessel in the brain bleeds, causing brain damage.

Symptoms of a stroke vary depending on which part of the brain is affected and how much damage occurs, but common symptoms include:

• Blurred vision or vision loss
• Loss of coordination
• Weakness or numbness on one side of the body
• Confusion
• Trouble speaking

Larger strokes are easier for doctors to identify because they can cause more noticeable changes in function, but smaller strokes can look like an MS attack.

The main differences include:

• Timing — Stroke symptoms appear suddenly within a few minutes, while MS flares typically develop over hours to days.
• MRI results — MS lesions typically show the central vein sign, while damage from a stroke does not.
• Vision symptoms — MS-related optic neuritis can cause blurred vision, eye pain, or vision loss, while stroke-related vision symptoms often appear suddenly.
• Other functional symptoms — A stroke is more likely to affect speech and comprehension, while an MS flare is more likely to cause muscle spasms, pain, or problems with bowel or bladder function.

Systemic Lupus Erythematosus

Systemic lupus erythematosus (SLE) — the most common form of lupus — is similar to MS because both are autoimmune diseases, meaning the immune system mistakenly attacks the body’s own tissues.

SLE can affect the joints, blood vessels, and organs, including the skin and kidneys. It can also affect the nervous system, leading to overlapping symptoms such as headaches, confusion, or memory loss.

In some cases, SLE can attack the brain and spinal cord, creating lesions similar to those seen in MS. In addition, the antinuclear antibody (ANA) blood test used to help evaluate SLE can be positive in other autoimmune diseases, such as MS.

The main differences between these conditions include:

• Symptom range — Unlike MS, lupus can cause symptoms throughout the body, including skin rashes, joint pain, and damage to organs such as the kidneys, heart, or lungs.
• MRI results — MS lesions often have the central vein sign, while SLE-related damage usually doesn’t.

Myasthenia Gravis

Myasthenia gravis (MG) is also an autoimmune disease that affects the nervous system at the neuromuscular junction — the place where nerves communicate with muscles to control movement.

People with MG have muscle weakness throughout the body, including in the face, arms, and legs. MG can also affect the muscles used for breathing and swallowing.

Both MG and MS affect nerve and muscle function, but in different ways. MS affects myelin, the covering around nerves, in the central nervous system (CNS), which includes the brain and spinal cord. MG often involves antibodies that target the acetylcholine receptors at the neuromuscular junction, which lies outside the CNS.

Other features of MG can help tell it apart from MS. Here are two ways:

• Serum tests — About 80 percent of people with MG have high levels of acetylcholine receptor antibodies. Testing positive for these antibodies can help support an MG diagnosis.
• Sensory changes — MG mainly affects the muscles, so it isn’t associated with numbness or tingling. These sensory symptoms are more commonly linked to MS.

Lyme Disease

Lyme disease is an infection caused by bacteria transmitted through tick bites. The bacteria can travel through the bloodstream, which can cause flu-like symptoms, fatigue, joint pain, and headaches.

If untreated for weeks or months, Lyme disease can cause nerve-related symptoms like tingling or numbness in the hands and feet or facial palsy (weakness of the muscles on one side of the face). It can also cause inflammation of the nervous system, including the brain.

When differentiating between nervous system symptoms of Lyme disease and MS, doctors may consider:

• Medical history — Your doctor may ask if you spend time outdoors or have had a tick bite before your symptoms began.
• Symptom pattern — MS mainly affects the nervous system, whereas Lyme disease is often associated with other symptoms, such as skin rash, fever, and joint pain.
• Medication — Lyme disease is treated with antibiotics, and symptoms often improve with treatment. MS is a chronic condition that requires different treatments.

Join the Conversation

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

How was your MS diagnosis journey? Did you and your care team consider alternative diagnoses? Let others know in the comments below.