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Background: Multiple sclerosis (MS) and acute disseminated encephalomyelitis (ADEM) are both inflammatory demyelinating diseases that affect the central nervous system (CNS). Unlike MS, the diagnosis of ADEM is rare and remains primarily clinical without an identifiable biomarker to distinguish it. Furthermore, misdiagnoses can occur between ADEM and MS because they have similar presentations at onset. As part of the healthcare team, physical therapists may be the first to notice the subtle clinical differences between these similar disease states. Thus, the purpose of this case is to compare and contrast the clinical presentation, pathogenesis, and diagnostic criteria of MS and ADEM, in order to better understand how to differentiate these two inflammatory demyelinating diseases of the CNS. Case Description: The patient was a 35-year-old woman hospitalized for dizziness, nausea, unsteady gait, and slurred speech that started initially as intermittent vertigo, but progressed over a 1-month period. The patient was transferred to the neurology unit and diagnostic testing was performed in order to determine potential diagnoses. Assessments: Due to the presentation of symptoms at onset, the patient received a computerized tomography angiography (CTA) of the head, magnetic resonance imaging (MRI) of the brain and cervical spine, and a lumbar puncture to retrieve cerebrospinal fluid (CSF) for analysis. Discussion: This case report represents the initial episode of symptom onset in an individual suffering from an inflammatory demyelinating disease of the CNS. Although this patient presented to the Emergency Department (ED) for worsening symptoms, her initial symptoms began one-month prior with intermittent vertigo. Physical therapists often evaluate and treat this diagnosis; therefore, it is vital to have an evolving knowledge of different diagnoses in order to identify the subtle signs of systemic involvement of disease and be a potential referral source to provide the highest quality care.