Fast Five Quiz: Multiple Sclerosis Diagnosis and Workup

Christopher Luzzio, MD


November 22, 2022

MRI alone cannot be used to diagnose MS; however, it remains the imaging procedure of choice for confirming MS and monitoring disease progression in the brain and spinal cord.

According to Grzegorski and colleagues, not all patients with clinically isolated syndrome develop MS. Historically, MS could not be diagnosed after a single symptomatic episode, given the requirement for lesions separated in time and space. However, the 2017 revised McDonald criteria allow diagnosis of MS in patients with a typical clinically isolated syndrome. Specifically, when there is clinical or MRI demonstration of dissemination in space, the presence of cerebrospinal fluid (CSF)-specific oligoclonal bands (OCBs) allows a diagnosis of MS. In addition, symptomatic lesions can be used to demonstrate dissemination in space or time in patients with supratentorial, infratentorial, or spinal cord syndromes, while cortical lesions can be used to demonstrate dissemination in space. Both asymptomatic and symptomatic MRI lesions can be considered in determining dissemination in space, apart from optic nerve lesions, which are excluded.

Learn more about diagnostic criteria for MS.


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