Differential diagnosis of demyelinating diseases: what's new? 2022

Ana Beatriz Ayroza Galvão Ribeiro Gomes, and Tarso Adoni
Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Departamento de Neurologia, São Paulo SP, Brazil.

Acquired demyelinating disorders lead to overlapping visual, pyramidal, sensory, autonomic, and cerebellar deficits and may lead to severe disability. Early diagnosis and start of treatment are fundamental towards preventing further attacks and halting disability. In this paper we provide an updated overview of the differential diagnoses of acquired demyelinating disorders. We performed a critical targeted review of the diagnoses of the most prevalent demyelinating disorders: multiple sclerosis (MS), neuromyelitis optica spectrum disorders (NMOSD) and myelin oligodendrocyte glycoprotein antibody disease (MOGAD). We discuss the workup, diagnostic criteria and new biomarkers currently being used for the diagnosis of these disease entities taking into account the particularities of the Brazilian population and healthcare system. A comprehensive analysis of medical history, physical examination, biomedical and imaging data should be performed to obtain differential diagnosis. Diagnostic criteria should be mindfully employed considering ethnic and environmental particularities of each patient.

UI MeSH Term Description Entries
D009103 Multiple Sclerosis An autoimmune disorder mainly affecting young adults and characterized by destruction of myelin in the central nervous system. Pathologic findings include multiple sharply demarcated areas of demyelination throughout the white matter of the central nervous system. Clinical manifestations include visual loss, extra-ocular movement disorders, paresthesias, loss of sensation, weakness, dysarthria, spasticity, ataxia, and bladder dysfunction. The usual pattern is one of recurrent attacks followed by partial recovery (see MULTIPLE SCLEROSIS, RELAPSING-REMITTING), but acute fulminating and chronic progressive forms (see MULTIPLE SCLEROSIS, CHRONIC PROGRESSIVE) also occur. (Adams et al., Principles of Neurology, 6th ed, p903) MS (Multiple Sclerosis),Multiple Sclerosis, Acute Fulminating,Sclerosis, Disseminated,Disseminated Sclerosis,Sclerosis, Multiple
D009471 Neuromyelitis Optica A syndrome characterized by acute OPTIC NEURITIS; MYELITIS, TRANSVERSE; demyelinating and/or necrotizing lesions in the OPTIC NERVES and SPINAL CORD; and presence of specific autoantibodies to AQUAPORIN 4. Devic Disease,Devic's Neuromyelitis Optica,Devic Neuromyelitis Optica,Devic Syndrome,Devic's Disease,Devic's Syndrome,NMO Spectrum Disorder,Neuromyelitis Optica (NMO) Spectrum Disorder,Neuromyelitis Optica (NMO) Spectrum Disorders,Neuromyelitis Optica Spectrum Disorder,Neuromyelitis Optica Spectrum Disorders,Devic Neuromyelitis Opticas,Devics Disease,Devics Neuromyelitis Optica,Devics Syndrome,Disease, Devic,Disease, Devic's,NMO Spectrum Disorders,Neuromyelitis Optica, Devic,Neuromyelitis Optica, Devic's,Neuromyelitis Opticas, Devic,Syndrome, Devic,Syndrome, Devic's
D003937 Diagnosis, Differential Determination of which one of two or more diseases or conditions a patient is suffering from by systematically comparing and contrasting results of diagnostic measures. Diagnoses, Differential,Differential Diagnoses,Differential Diagnosis
D006233 Disabled Persons Persons with physical or mental disabilities that affect or limit their activities of daily living and that may require special accommodations. Handicapped,People with Disabilities,Persons with Disabilities,Physically Challenged,Physically Handicapped,Physically Disabled,Disabilities, People with,Disabilities, Persons with,Disability, Persons with,Disabled Person,Disabled, Physically,Handicapped, Physically,People with Disability,Person, Disabled,Persons with Disability,Persons, Disabled
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D001323 Autoantibodies Antibodies that react with self-antigens (AUTOANTIGENS) of the organism that produced them. Autoantibody
D051401 Aquaporin 4 Aquaporin 4 is the major water-selective channel in the CENTRAL NERVOUS SYSTEM of mammals. AQP4 Protein,Aquaporin 4 Protein
D063308 Myelin-Oligodendrocyte Glycoprotein A transmembrane protein present in the MYELIN SHEATH of the CENTRAL NERVOUS SYSTEM. It is one of the main autoantigens implicated in the pathogenesis of MULTIPLE SCLEROSIS. MOG Glycoprotein,Glycoprotein, Myelin-Oligodendrocyte,Myelin Oligodendrocyte Glycoprotein

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