Differential Diagnosis for Evanescent Fluctuating CNS Lesions with Oligoclonal Bands
- Single Most Likely Diagnosis
- Multiple Sclerosis (MS): This is the most likely diagnosis due to the presence of evanescent and fluctuating CNS lesions, which are characteristic of MS relapses, along with oligoclonal bands in the cerebrospinal fluid (CSF), a hallmark of the disease.
- Other Likely Diagnoses
- Neuromyelitis Optica Spectrum Disorder (NMOSD): Although less common than MS, NMOSD can present with fluctuating CNS lesions and oligoclonal bands, particularly in patients with a history of optic neuritis or transverse myelitis.
- Acute Disseminated Encephalomyelitis (ADEM): ADEM can mimic MS but typically presents with a monophasic illness and may have oligoclonal bands, although this is less common than in MS.
- Do Not Miss Diagnoses
- Central Nervous System Lymphoma: Although rare, CNS lymphoma can present with fluctuating neurological deficits and may have oligoclonal bands, making it a critical diagnosis not to miss due to its aggressive nature and need for prompt treatment.
- Infectious Encephalitis (e.g., Lyme disease, syphilis): Certain infections can cause CNS lesions and oligoclonal bands, and missing these diagnoses could lead to severe consequences if not treated appropriately.
- Rare Diagnoses
- Susac Syndrome: A rare condition characterized by microangiopathic changes in the brain, retina, and cochlea, which can present with fluctuating CNS lesions and may have oligoclonal bands.
- Bickerstaff Brainstem Encephalitis: A rare inflammatory disorder of the brainstem that can present with fluctuating neurological deficits, although oligoclonal bands are not a typical feature.