Red flags in multiple sclerosis

The diagnosis of multiple sclerosis (MS) is often challenging and misdiagnosis remains an important contemporary problem, with considerable consequences for patients. This review aims to specify the appropriate approach in differential diagnosis of MS, highlight the clinical and paraclinical red flags and create a new perspective to the clinicians.

The accurate diagnosis of MS is challenged by a broad and heterogeneous spectrum of diseases. The differential diagnosis should be based on the combined evaluation of typical clinical, radiological and laboratory findings. Studies have been recently published reported that 7.1-24.4% of patients have been misdiagnosed with MS. The most frequent correct alternative diagnoses were white matter ischemic disease and migraine.

Differential diagnosis of MS requires a holistic approach dependent on the clinical presentation and accompanied by vigilance for clinical and paraclinical red flags suggesting alternative diagnoses. Misdiagnosis could have the potential dangerous consequences for patients, including aggressive immunosuppressive therapies.