title: Why this is not multiple sclerosis: a case based approach.
abstract: 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.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Universidade Federal de São Paulo, Sao Paulo, SP, Brazil.
authors.forename: Zaira Fernanda Martinho
authors.initials: ZF
authors.lastname: Nicolau
authors.affiliation: Universidade Federal de São Paulo, Sao Paulo, SP, Brazil.
authors.forename: Enedina Maria Lobato de
authors.initials: EM
authors.lastname: Oliveira
authors.affiliation: Universidade Federal de São Paulo, Sao Paulo, SP, Brazil.
authors.forename: Denis Bernardi
authors.initials: DB
authors.lastname: Bichuetti
mesh_terms: D000328:Adult; D003937:Diagnosis, Differential; D003951:Diagnostic Errors; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000175:diagnosis*; D055815:Young Adult