Neuromyelitis optica spectrum disorder (NMOSD): clinical differentials

Written and reviewed by Dr Ibrahim Imam, Consultant Neurologist. Last reviewed .

Neuromyelitis optica spectrum disorder (NMOSD): clinical differentials. Multiple sclerosis (MS). Fully referenced neurology checklist.

Inflammatory

  • Multiple sclerosis (MS)
  • Anti MOG antibody syndrome
  • Acute disseminated encephalomyelitis (ADEM)
  • Idiopathic acute transverse myelitis
  • Idiopathic optic neuritis
  • Neuro Behcet’s disease
  • Sarcoidosis
  • Sjogren’s syndrome
  • Systemic lupus erythematosus (SLE)

Viral

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Other infections

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Other clinical differentials

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Red flags against NMO diagnosis

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Radiological differentials

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References

  1. Kim SM, Kim SJ, Lee HJ, Kuroda H, Palace J, Fujihara K. Differential diagnosis of neuromyelitis optica spectrum disorders. Ther Adv Neurol Disord 2017; 10:265-289.
  2. Süße M, Feistner F, Grothe M, Nauck M, Dressel A, Hannich MJ. Free light chains kappa can differentiate between myelitis and noninflammatory myelopathy. Neurol Neuroimmunol Neuroinflamm 2020; 7:e892.
  3. Tan H, Deng X, ZhangBao J, et al. KFLC-index distinguishes multiple sclerosis from anti-myelin oligodendrocyte glycoprotein and aquaporin 4 diseases in a Chinese cohort. JNNP 2025 (Online ahead of print).
  4. Qin C, Chen B, Tao R, et al. The clinical value of complement proteins in differentiating AQP4-IgG-positive from MOG-IgG-positive neuromyelitis optica spectrum disorders. Mult Scler Relat Disord 2019; 35:1-4. 
  5. Enomoto S, Shigemi H, Kitazaki Y, et al. Cladophialophora bantiana infection mimicking neuromyelitis optica. J Neurol Sci 2019; 399:169-171. 
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