Diagnosis and Differential Diagnosis of Multiple Sclerosis

The criteria of the Schumacher committee appear to be the most practical set of requirements for the clinical diagnosis of multiple sclerosis. Multiplicity in both time and space are essential for this disease. A combination of optic nerve involvement, long-tract signs and evidence of brain-stem dysfunction is a constellation which is most likely to be due to multiple sclerosis in young individuals. Even here though, other disorders need be kept in mind: Leber's optic atrophy, heredofamilial spinocerebellar degenerations, nutritional disorders, ischemic and inflammatory vascular disease. When the eye is not involved, one need also consider Behçet's disease and other chronic meningoencephalitides. Regardless what the course of illness has been, a lack of spatial dissemination within the central nervous system precludes a diagnosis of MS. Brain stem or spinal cord disorders are notorious for causing disturbances suspicious of multiple lesions when in fact a single local lesion is operative. Early development of dementia or seizures, or the presence of extrapyramidal signs, stupor, aphasia, or focal atrophy with fasciculations is in each instance most unusual in MS.