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* '''Vitamin B12 deficiency:''' [[Vitamin B12|B12]] deficiency can cause [[neurological]] manifestation including [[peripheral neuropathy]], [[optic neuropathy]], cervical myelopathy and fatigue.<ref name="pmid8618695">{{cite journal |vauthors=Chatterjee A, Yapundich R, Palmer CA, Marson DC, Mitchell GW |title=Leukoencephalopathy associated with cobalamin deficiency |journal=Neurology |volume=46 |issue=3 |pages=832–4 |year=1996 |pmid=8618695 |doi= |url=}}</ref> [[MRI]] findings include contrast enhancement of posterior and lateral [[spinal cord]] columns preferably in cervical and thoracic levels.<ref name="pmid10068811">{{cite journal |vauthors=Locatelli ER, Laureno R, Ballard P, Mark AS |title=MRI in vitamin B12 deficiency myelopathy |journal=Can J Neurol Sci |volume=26 |issue=1 |pages=60–3 |year=1999 |pmid=10068811 |doi= |url=}}</ref>
* '''Vitamin B12 deficiency:''' [[Vitamin B12|B12]] deficiency can cause [[neurological]] manifestation including [[peripheral neuropathy]], [[optic neuropathy]], cervical myelopathy and fatigue.<ref name="pmid8618695">{{cite journal |vauthors=Chatterjee A, Yapundich R, Palmer CA, Marson DC, Mitchell GW |title=Leukoencephalopathy associated with cobalamin deficiency |journal=Neurology |volume=46 |issue=3 |pages=832–4 |year=1996 |pmid=8618695 |doi= |url=}}</ref> [[MRI]] findings include contrast enhancement of posterior and lateral [[spinal cord]] columns preferably in cervical and thoracic levels.<ref name="pmid10068811">{{cite journal |vauthors=Locatelli ER, Laureno R, Ballard P, Mark AS |title=MRI in vitamin B12 deficiency myelopathy |journal=Can J Neurol Sci |volume=26 |issue=1 |pages=60–3 |year=1999 |pmid=10068811 |doi= |url=}}</ref>
* '''Lysosomal disorders:'''
* '''Lysosomal disorders:'''
# Metachromatic leukodystrophy: MLD is an autosomal recessive lysosomal storage disease that leads to accumulation of galactosyl sulfatide in brain white matter, peripheral nerves and some other organs.<ref name="pmid14086829">{{cite journal |vauthors=AUSTIN JH, BALASUBRAMANIAN AS, PATTABIRAMAN TN, SARASWATHI S, BASU DK, BACHHAWAT BK |title=A CONTROLLED STUDY OF ENZYMIC ACTIVITIES IN THREE HUMAN DISORDERS OF GLYCOLIPID METABOLISM |journal=J. Neurochem. |volume=10 |issue= |pages=805–16 |year=1963 |pmid=14086829 |doi= |url=}}</ref><ref name="pmid14338983">{{cite journal |vauthors=MEHL E, JATZKEWITZ H |title=EVIDENCE FOR THE GENETIC BLOCK IN METACHROMATIC LEUCODYSTROPHY (ML) |journal=Biochem. Biophys. Res. Commun. |volume=19 |issue= |pages=407–11 |year=1965 |pmid=14338983 |doi= |url=}}</ref>
# Metachromatic leukodystrophy: MLD is an autosomal recessive lysosomal storage disease that leads to accumulation of galactosyl sulfatide.<ref name="pmid14086829">{{cite journal |vauthors=AUSTIN JH, BALASUBRAMANIAN AS, PATTABIRAMAN TN, SARASWATHI S, BASU DK, BACHHAWAT BK |title=A CONTROLLED STUDY OF ENZYMIC ACTIVITIES IN THREE HUMAN DISORDERS OF GLYCOLIPID METABOLISM |journal=J. Neurochem. |volume=10 |issue= |pages=805–16 |year=1963 |pmid=14086829 |doi= |url=}}</ref><ref name="pmid14338983">{{cite journal |vauthors=MEHL E, JATZKEWITZ H |title=EVIDENCE FOR THE GENETIC BLOCK IN METACHROMATIC LEUCODYSTROPHY (ML) |journal=Biochem. Biophys. Res. Commun. |volume=19 |issue= |pages=407–11 |year=1965 |pmid=14338983 |doi= |url=}}</ref>
# Fabry’s disease:
# Fabry’s disease:
# Krabbe’s disease:
# Krabbe’s disease:
* '''Adrenoleukodystrophy:''' [[Adrenoleukodystrophy|ALD]] disease causes accumulation of [[long chain fatty acids]]. [[X-linked]] type of this disease ([[adrenomyeloneuropathy]]) will cause [[spinal cord]] disease and peripheral [[neuropathy]] and can be considered as a [[differential diagnosis]] of [[MS]] disease.<ref name="pmid3978476">{{cite journal |vauthors=Dooley JM, Wright BA |title=Adrenoleukodystrophy mimicking multiple sclerosis |journal=Can J Neurol Sci |volume=12 |issue=1 |pages=73–4 |year=1985 |pmid=3978476 |doi= |url=}}</ref>
* '''Adrenoleukodystrophy:''' [[Adrenoleukodystrophy|ALD]] disease causes accumulation of [[long chain fatty acids]]. [[X-linked]] type of this disease ([[adrenomyeloneuropathy]]) will cause [[spinal cord]] disease and peripheral [[neuropathy]] and can be considered as a [[differential diagnosis]] of [[MS]] disease.<ref name="pmid3978476">{{cite journal |vauthors=Dooley JM, Wright BA |title=Adrenoleukodystrophy mimicking multiple sclerosis |journal=Can J Neurol Sci |volume=12 |issue=1 |pages=73–4 |year=1985 |pmid=3978476 |doi= |url=}}</ref>
* '''mitochondrial encephalopathy epilepsy lactic acidosis and stroke:''' One of the [[mitochondrial diseases]] that can categorized as a [[MS]] [[differential diagnosis]] in [[Mitochondrial encephalomyopathy, lactic acidosis, and stroke-like episodes|mitochondrial encephalopathy epilepsy lactic acidosis and stroke]] ([[MELAS]]). The manifestations include: [[Seizures]], exercise intolerance, [[limb]] [[weakness]], [[stroke]] like episodes, [[hemiparesis]] and [[hemianopia]]. There are evidences of calcium deposition in [[caudate nucleus]] and [[globus pallidus]] in [[CT scan]] and cortical involvement in [[MRI]] imaging.<ref name="pmid2398945">{{cite journal |vauthors=Rosen L, Phillips S, Enzmann D |title=Magnetic resonance imaging in MELAS syndrome |journal=Neuroradiology |volume=32 |issue=2 |pages=168–71 |year=1990 |pmid=2398945 |doi= |url=}}</ref>
* '''mitochondrial encephalopathy epilepsy lactic acidosis and stroke:''' One of the [[mitochondrial diseases]] that can categorized as a [[MS]] [[differential diagnosis]] in [[Mitochondrial encephalomyopathy, lactic acidosis, and stroke-like episodes|mitochondrial encephalopathy epilepsy lactic acidosis and stroke]] ([[MELAS]]). The manifestations include: [[Seizures]], exercise intolerance, [[limb]] [[weakness]], [[stroke]] like episodes, [[hemiparesis]] and [[hemianopia]]. There are evidences of calcium deposition in [[caudate nucleus]] and [[globus pallidus]] in [[CT scan]] and cortical involvement in [[MRI]] imaging.<ref name="pmid2398945">{{cite journal |vauthors=Rosen L, Phillips S, Enzmann D |title=Magnetic resonance imaging in MELAS syndrome |journal=Neuroradiology |volume=32 |issue=2 |pages=168–71 |year=1990 |pmid=2398945 |doi= |url=}}</ref>
* '''Clinically defined genetic disorders:'''


==== CNS lymphoma ====
==== '''CNS lymphoma''' ====
[[Primary CNS lymphoma]] is mostly [[diffuse large B-cell lymphoma]] ([[Diffuse large B cell lymphoma|DLBCL]]).<ref name="pmid9166827">{{cite journal |vauthors= |title=A clinical evaluation of the International Lymphoma Study Group classification of non-Hodgkin's lymphoma. The Non-Hodgkin's Lymphoma Classification Project |journal=Blood |volume=89 |issue=11 |pages=3909–18 |year=1997 |pmid=9166827 |doi= |url=}}</ref> These patients more commonly present with [[neurological]] manifestation rather than [[B symptoms]].<ref name="pmid10659013">{{cite journal |vauthors=Bataille B, Delwail V, Menet E, Vandermarcq P, Ingrand P, Wager M, Guy G, Lapierre F |title=Primary intracerebral malignant lymphoma: report of 248 cases |journal=J. Neurosurg. |volume=92 |issue=2 |pages=261–6 |year=2000 |pmid=10659013 |doi=10.3171/jns.2000.92.2.0261 |url=}}</ref> In [[MRI]] evaluation, because of high cell count and scant [[cytoplasm]] lesions become isotense to hypointense on T2.<ref name="pmid15925998">{{cite journal |vauthors=Küker W, Nägele T, Korfel A, Heckl S, Thiel E, Bamberg M, Weller M, Herrlinger U |title=Primary central nervous system lymphomas (PCNSL): MRI features at presentation in 100 patients |journal=J. Neurooncol. |volume=72 |issue=2 |pages=169–77 |year=2005 |pmid=15925998 |doi=10.1007/s11060-004-3390-7 |url=}}</ref> In [[CSF]] analysis, there are increased number of [[WBC]] and proteins, low levels of glucose and positive [[cytology]] for cells with enlarged [[nucleus]] and course [[chromatin]].<ref name="pmid16083830">{{cite journal |vauthors=Fitzsimmons A, Upchurch K, Batchelor T |title=Clinical features and diagnosis of primary central nervous system lymphoma |journal=Hematol. Oncol. Clin. North Am. |volume=19 |issue=4 |pages=689–703, vii |year=2005 |pmid=16083830 |doi=10.1016/j.hoc.2005.05.009 |url=}}</ref>


==== spinal diseases ====
==== spinal diseases ====

Revision as of 21:37, 18 February 2018

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

  • Overview

Differentiating multiple sclerosis from other diseases

Multiple sclerosis must be differentiated from other diseases that can mimic this disease clinically or radiologically such as:

Inflammatory/autoimmune conditions:

Infections:

Metabolic and Genetic/Heriditary Disorders:

  1. Metachromatic leukodystrophy: MLD is an autosomal recessive lysosomal storage disease that leads to accumulation of galactosyl sulfatide.[34][35]
  2. Fabry’s disease:
  3. Krabbe’s disease:

CNS lymphoma

Primary CNS lymphoma is mostly diffuse large B-cell lymphoma (DLBCL).[38] These patients more commonly present with neurological manifestation rather than B symptoms.[39] In MRI evaluation, because of high cell count and scant cytoplasm lesions become isotense to hypointense on T2.[40] In CSF analysis, there are increased number of WBC and proteins, low levels of glucose and positive cytology for cells with enlarged nucleus and course chromatin.[41]

spinal diseases

References

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  33. Locatelli ER, Laureno R, Ballard P, Mark AS (1999). "MRI in vitamin B12 deficiency myelopathy". Can J Neurol Sci. 26 (1): 60–3. PMID 10068811.
  34. AUSTIN JH, BALASUBRAMANIAN AS, PATTABIRAMAN TN, SARASWATHI S, BASU DK, BACHHAWAT BK (1963). "A CONTROLLED STUDY OF ENZYMIC ACTIVITIES IN THREE HUMAN DISORDERS OF GLYCOLIPID METABOLISM". J. Neurochem. 10: 805–16. PMID 14086829.
  35. MEHL E, JATZKEWITZ H (1965). "EVIDENCE FOR THE GENETIC BLOCK IN METACHROMATIC LEUCODYSTROPHY (ML)". Biochem. Biophys. Res. Commun. 19: 407–11. PMID 14338983.
  36. Dooley JM, Wright BA (1985). "Adrenoleukodystrophy mimicking multiple sclerosis". Can J Neurol Sci. 12 (1): 73–4. PMID 3978476.
  37. Rosen L, Phillips S, Enzmann D (1990). "Magnetic resonance imaging in MELAS syndrome". Neuroradiology. 32 (2): 168–71. PMID 2398945.
  38. "A clinical evaluation of the International Lymphoma Study Group classification of non-Hodgkin's lymphoma. The Non-Hodgkin's Lymphoma Classification Project". Blood. 89 (11): 3909–18. 1997. PMID 9166827.
  39. Bataille B, Delwail V, Menet E, Vandermarcq P, Ingrand P, Wager M, Guy G, Lapierre F (2000). "Primary intracerebral malignant lymphoma: report of 248 cases". J. Neurosurg. 92 (2): 261–6. doi:10.3171/jns.2000.92.2.0261. PMID 10659013.
  40. Küker W, Nägele T, Korfel A, Heckl S, Thiel E, Bamberg M, Weller M, Herrlinger U (2005). "Primary central nervous system lymphomas (PCNSL): MRI features at presentation in 100 patients". J. Neurooncol. 72 (2): 169–77. doi:10.1007/s11060-004-3390-7. PMID 15925998.
  41. Fitzsimmons A, Upchurch K, Batchelor T (2005). "Clinical features and diagnosis of primary central nervous system lymphoma". Hematol. Oncol. Clin. North Am. 19 (4): 689–703, vii. doi:10.1016/j.hoc.2005.05.009. PMID 16083830.