Table 1

Differential diagnosis by speed of onset and lesion length

OnsetMRI sagittalDifferential
HyperacuteLongSpinal cord infarction
Neuromyelitis optica spectrum disorder (rare; documented only in AQP4-antibody positive cases)
Haemorrhage
ShortHaemorrhage
Acute/subacuteLongNeuromyelitis optica spectrum disorder
Autoimmune
Infective (most commonly viral)
Acute disseminated encephalomyelitis
Paraneoplastic
Sarcoidosis
VascularSpinal cord infarction
Malformation
Metabolic
NeoplasticEpendymoma
ShortMultiple sclerosis (up to 32% of clinically isolated syndrome)
InfectiveViral
Tuberculosis
Parasitic
Autoimmune
Sarcoidosis
Atypical neuromyelitis optica spectrum disorder (14%)
Chronic/progressiveLongParaneoplastic
Sarcoidosis
Atypical multiple sclerosis (long-standing or primary progressive)
Chronic infectionSyphilis
HTLV-1
HIV
VascularMalformation
Metabolic
NeoplasticEpendymoma
Astrocytoma
ShortSarcoidosis
Multiple sclerosis (primary or secondary progressive)
NeoplasticAstrocytoma
Ependymoma
Metastatic
Relapsing/fluctuatingLongNeuromyelitis optica spectrum disorder
VascularMalformation
Sarcoidosis
ShortMultiple sclerosis
  • AQP4, aquaporin-4; HTLV-1, human T cell lymphotropic virus type 1.