Neuromyelitis optica spectrum disorder (NMOSD): clinical differentials

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

Other infections

Other clinical differentials

Red flags against NMO diagnosis

Radiological differentials

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. 
6. And 4 more. Subscribe to see the full list

Related checklists

• Neuromyelitis optica spectrum disorders (NMOSD): diagnostic criteria
• Neuromyelitis optica spectrum disorder (NMOSD): central neurological features
• Neuromyelitis optica spectrum disorder (NMOSD): peripheral neurological features
• Neuromyelitis optica spectrum disorder (NMOSD): systemic features
• Neuromyelitis optica spectrum disorder (NMOSD): paraneoplastic
• Neuromyelitis optica spectrum disorder (NMOSD): area postrema syndrome (APS)
• Neuromyelitis optica spectrum disorder (NMOSD): prognostic factors