Fast Five Quiz: Multiple Sclerosis Presentation and Diagnosis

Christopher Luzzio, MD


July 30, 2020

According to the 2017 revised McDonald criteria for MS diagnosis, two or more attacks and objective clinical evidence of two or more lesions with reasonable historical evidence of a prior attack are sufficient clinical evidence to make a diagnosis of MS, although additional evidence, such as a brain MRI, is desirable and must be consistent with MS.

The hallmark of MS is symptomatic episodes "separated in time and space" (occurring months or years apart and affecting different CNS locations). For combinations of attacks plus lesions that add up to less evidence than the scenario described above, additional data are required to confirm MS as the diagnosis. For example, two or more attacks plus evidence of only one lesion could indicate MS, but only if confirmed by MRI-demonstrated dissemination in space or a further attack implicating a different site; on the other hand, two or more lesions with only one attack would require MRI-confirmed evidence of dissemination in time, a second attack, or demonstration of CSF-specific oligoclonal bands. Even more information would be required for an MS diagnosis when presented with a single attack and a single lesion (ie, CIS): MRI-demonstrated dissemination of space and time or a second attack implicating a different site.

Learn more about the diagnosis and presentation of MS.


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