Why this is not multiple sclerosis: a case based approach.

OBJECTIVE To present a case series of patients previously diagnosed as multiple sclerosis (MS) which were later confirmed as an alternative diagnosis, and describe the clinical and paraclinical signs that led to this change. METHOD Nine patients are described. We reviewed the patient's clinical chart, magnetic resonance images (MRI) and cerebrospinal fluid. RESULTS There was a mean of three typical symptoms of MS and four clinical red flags per patient. MRI red flags were found in 88,9% of all referrals, with a mean of 3 encountered per patient. CONCLUSION We identified that, not only the misdiagnosed patients did not fulfill MS diagnosis criteria, but also how the described red flags are a useful tool in the differentiation of MS from other diseases. This data is important for guiding future diagnosis, especially for general clinicians and neurologists, which directly interfere with the patient's management, treatment, prognosis and quality of life.