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Differential diagnosis

SIMILAR SIGNS AND SYMPTOMS

The symptoms of Alexander disease overlap with many childhood and adult neurological conditions, and because it is a rare disease not often seen by healthcare providers, it may not be considered on the differential diagnosis.1,4,51 

Alexander disease should be considered in a differential diagnosis of people who present with suggestive clinical signs and symptoms, which vary based on age of onset.13,23 

A man reviews a wall of brain scans with one highlighted in red.

DIFFERENTIAL DIAGNOSIS

 Neurologic conditions with clinical symptoms similar to those of Alexander disease stratified by age of disease onset1,4,23,24,64,65,a:

  • Adrenoleukodystrophy
  • Canavan disease
  • Krabbe disease
  • Brain tumors
  • Epilepsy
  • Metachromatic leukodystrophy
  • Glutaric acidurias
  • Zellweger spectrum disorder
  • Megalencephalic leukodystrophy
  • Leigh syndrome  
  • Tay-Sachs disease
  • Hydrocephalus
  • Pelizaeus-Merzbacher disease 
  • Multiple sclerosis
  • Multisystem atrophy
  • Amyotrophic lateral sclerosis
  • Brain tumors
  • X-linked adrenoleukodystrophy
  • Glutaric acidurias
  • Primary lateral sclerosis
  • Spinocerebellar ataxia
  • Cervical myelopathy
  • Neuromyelitis optica
  • Myasthenia gravis

aDifferential diagnoses in juvenile and adolescent patients will reflect the presenting symptoms, which may resemble those associated with earlier age of Alexander disease onset, later age of Alexander disease onset, or a mix of both.2,3,16

Genetic testing

If Alexander disease is suspected based on symptoms and/or MRI findings, genetic testing can confirm the diagnosis.1