ORIGINAL RESEARCH article
Front. Neurol.
Sec. Multiple Sclerosis and Neuroimmunology
Differential Diagnoses of MS in Clinical Practice: Incidence and Methods for Differential Diagnosis
Provisionally accepted
- University Medical Center Regensburg, Regensburg, Germany
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Background and Objectives: The diagnosis of multiple sclerosis (MS) is based on the McDonald diagnostic criteria and the exclusion of relevant differential diagnoses. The aim of this study was to determine the relative frequency of differential diagnoses of MS and to identify which diagnostic measures are most effective in distinguishing them from one another. Methods: We conducted a retrospective analysis of all cases treated in the neurology ward of the University Hospital Regensburg during the years 2019 and 2020. Inclusion criteria comprised cases presenting with subacute focal neurological symptoms accompanied by corresponding lesions on magnetic resonance imaging (MRI) that could not be primarily attributed to MS, tumor, hemorrhage or ischemia, as well as cases with abnormal external MRI findings who were referred to our clinic for the evaluation or exclusion of a multiple sclerosis. Results: A total of 127 cases were included in the study. Differential diagnoses of MS were predominantly of inflammatory and vascular origin or unspecific white matter lesions. The primary diagnostic tools for distinguishing differential diagnoses of MS from one another were patient history (fever), cerebrospinal fluid analysis and brain MRI, as well as duplex ultrasound of the cranial vessels. Discussion: Our study demonstrates that cerebrospinal fluid analysis and brain MRI are not only crucial for the diagnosis of MS but also for distinguishing among the various MS differential diagnoses. Especially regarding vascular lesions, duplex ultrasound may assist in the diagnostic process and the occurrence of fever may suggest an infectious cause.
Keywords: Differential diagnoses, Multiple Sclerosis, Duplex ultrasound, Cerebrospinal Fluid, Cranial MRI, Multiple sclerosis mimics
Received: 29 Aug 2025; Accepted: 10 Nov 2025.
Copyright: © 2025 Steinberg, Mayer, Freudenstein, Angstwurm, Linker and Lee. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Tim Johannes Steinberg, tim.steinberg@yahoo.de
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