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It highlights how understanding the expanding clinical spectrum of multiple sclerosis overlap conditions, neuromyelitis optica spectrum disorder (NMOSD, AQP4-IgG), and MOGAD has improved MRI-based characterization. Accurate diagnosis requires integrating clinical, radiologic, and laboratory data, and differentiating demyelinating disorders from important nondemyelinating differential diagnoses across supratentorial, brainstem, and spinal cord sites.",{"@graph":69,"@context":123},[70,84,106],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/diagnostic-approach-to-presumptive-demyelinating-solitary-cns-lesions-review-article/525935/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/diagnostic-approach-to-presumptive-demyelinating-solitary-cns-lesions-review-article/525935.png","ImageObject",300,407,{"name":92,"@type":93},"Liam","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-11-11","2026-10-08",true,{"@type":102,"interactionType":103,"userInteractionCount":105},"InteractionCounter",{"@type":104},"ViewAction",11,{"@type":107,"mainEntity":108},"FAQPage",[109,115,119],{"name":110,"@type":111,"acceptedAnswer":112},"What is the main goal of this article?","Question",{"text":113,"@type":114},"The article focuses on diagnostic approaches for solitary central nervous system lesions with a presumed demyelinating etiology, emphasizing accurate differentiation among demyelinating disorders and their key alternatives.","Answer",{"name":116,"@type":111,"acceptedAnswer":117},"Why has MRI characterization become more accurate recently?",{"text":118,"@type":114},"Broader recognition of the clinical spectrum across MS overlap conditions, AQP4-IgG NMOSD, and MOGAD has combined with MRI improvements to better define features of solitary demyelinating lesions.",{"name":120,"@type":111,"acceptedAnswer":121},"What key data types are needed to diagnose a solitary demyelinating lesion?",{"text":122,"@type":114},"Diagnosis requires careful consideration of clinical, radiologic, and laboratory data, using a structured approach to determine whether the lesion belongs to MS-spectrum conditions or to NMOSD/MOGAD.","https://schema.org",{"og:url":83,"og:type":125,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":127,"canonical":83},"index,follow",{"doc_id":129,"site_id":62},525935,1791701287,{"code":4,"msg":5,"data":132},{"doc_id":129,"user_id":133,"nickname":92,"user_avatar":134,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":135,"file_id":136,"file_url":137,"file_type":138,"file_size":139,"view_count":105,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":140,"language":141,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":142,"faqs":143,"seo_title":144,"seo_description":67,"update_tm":145,"read_time":146,"preview_page_count":4},8796095461564,"https://ap-avatar.wpscdn.com/davatar_155a257f0dc6eb9ab79c44ca47cae57d","Downloaded from [https://continuum.aan.com by Hebrew University of Jerusalem-Israel on 20 June 2026](https://continuum.aan.com by Hebrew University of Jerusalem-Israel on 20 June 2026)  \nREVIEW ARTICLE  \nCONTINUUM AUDIO INTERVIEW AVAI LABLEON LINE  \nCONTINUUM ALOUD RECORDING AVAI LAB LEON LINE  \nC ITE AS :  \nCONTINUUM (MIN NEA P M INN) 2026;32(2, MULTIPLE SCLEROSIS AND RELATED DISORDERS):424–455.  \nAddress correspondence to Dr Todd A. Hardy, Concord Hospital, Hospital Rd, Concord, NSW 2139, Australia, [thar6109@sydney.edu.au](thar6109@sydney.edu.au).  \nRELATIONSHIP DISCLOSURE: Dr Hardy has received personal compensation in the range of $500 to $4999 for serving on a scientific advisory or data safety monitoring board for Merck & Co. , Inc and on a speakers bureau for Novartis AG; in the range of $5000 to $9999 for serving on a scientific advisory or data safety monitoring board for Biogen and on a speakers bureau for Bristol Myers Squibb Company and Merck & Co. , Inc; and in the range of $10,000 to $49,999 for serving as an expert writer with MS Research Reviews.  \nContinued on page 455  \nUNLABELED USE OF PRODUCTS/ INVESTIGATIONAL USE DISCLOSURE:  \nDr Hardy reports no disclosure.  \nAll cases in this article are hypothetical or composite.  \n© 2026 American Academy of Neurology.  \nDiagnostic Approach to Presumptive Demyelinating Solitary CNS Lesions  \nBy Todd A. Hardy, BSc (Hons), PhD, MBBS, FRACP  \nABSTRACT  \nOBJECTIVE: This article focuses on diagnostic approaches to solitary lesions in the central nervous system with a presumed demyelinating etiology.  \nLATEST DEVELOPMENTS: A greater understanding of the broad spectrum of presentations of multiple sclerosis overlap conditions, aquaporin-4 neuromyelitis optica spectrum disorder (NMOSD), and myelin oligodendrocyte glycoprotein antibody–associated disease (MOGAD) has combined with improvements in MRI to better define the characteristics of solitary demyelinating lesions, leading to more accurate diagnosis.  \nESSENTIAL POINTS: Diagnosing a single demyelinating lesion in the supratentorial brain, brainstem, or spinal cord requires careful consideration of clinical, radiologic, and laboratory data. A key approach is to establish whether a solitary lesion may be part of a presentation seen in multiple sclerosis or other conditions that overlap with multiple sclerosis, such as tumefactive demyelination or solitary sclerosis, or whether it could be due to NMOSD or MOGAD. This article presents clues to the diagnosis of a presumed solitary demyelinating lesion and draws attention to important nondemyelinating conditions that can form the differential diagnosis at each of these sites in the central nervous system.  \nINTRODUCTION  \nA  \nsolitary lesion in the central nervous system (CNS) with ademyelinating etiology occurs infrequently in clinical practice, but it can cause disabling symptoms and may represent a diagnostic challenge. Several demyelinating conditions can present with a solitary lesion, and investigations are useful to  \ndetermine the cause. It is also important to exclude nondemyelinating conditions as part of the differential diagnosis; these broadly include neoplasm, infection, granulomatous disease, metabolic conditions, and vascular disorders. Early and accurate characterization of a demyelinating  \n424 CONTINUUM . AAN . COM  \nCopyright © 2026 American Academy of Neurology. Unauthorized reproduction of this article is prohibited.  \nDownloaded from [https://continuum.aan.com by Hebrew University of Jerusalem-Israel on 20 June 2026](https://continuum.aan.com by Hebrew University of Jerusalem-Israel on 20 June 2026)  \nlesion is important because the consequences of delayed diagnosis can be harmful, and treatment options differ according to diagnosis.  \nThe MRI characteristics of a solitary CNS lesion are critical, and they maybe sufficient for establishing a clinicoradiologic diagnosis, but ancillary investigations with other imaging modalities, neurophysiology, CSF examinatio","cbCaimsVxvDHLl5z","https://ap.wps.com/l/cbCaimsVxvDHLl5z","pdf",2062578,32,"English","# ABSTRACT\n# OBJECTIVE\n# LATEST DEVELOPMENTS\n# ESSENTIAL POINTS\n# INTRODUCTION\n# DIAGNOSING DEMYELINATING CONDITIONS OF THE CNS","[{\"question\":\"What is the main goal of this article?\",\"answer\":\"The article focuses on diagnostic approaches for solitary central nervous system lesions with a presumed demyelinating etiology, emphasizing accurate differentiation among demyelinating disorders and their key alternatives.\"},{\"question\":\"Why has MRI characterization become more accurate recently?\",\"answer\":\"Broader recognition of the clinical spectrum across MS overlap conditions, AQP4-IgG NMOSD, and MOGAD has combined with MRI improvements to better define features of solitary demyelinating lesions.\"},{\"question\":\"What key data types are needed to diagnose a solitary demyelinating lesion?\",\"answer\":\"Diagnosis requires careful consideration of clinical, radiologic, and laboratory data, using a structured approach to determine whether the lesion belongs to MS-spectrum conditions or to NMOSD/MOGAD.\"}]","Diagnostic Approach to Presumptive Demyelinating Solitary CNS Lesions - Review Article | PDF",1791493987,81]