J Clin Neurol.  2018 Jul;14(3):387-392. 10.3988/jcn.2018.14.3.387.

Clinical Application of 2017 McDonald Diagnostic Criteria for Multiple Sclerosis

• Mantero V
• Abate L
• Balgera R
• La Mantia
• Salmaggi A

• KMID: 2415057
• DOI: http://doi.org/10.3988/jcn.2018.14.3.387

Abstract

BACKGROUND AND PURPOSE
McDonald criteria for multiple sclerosis diagnosis have been revised over the years, diagnostic procedures have been simplified and earlier diagnosis facilitated. The new 2017 revision introduces other important changes, with a further simplification for the diagnosis. Oligoclonal bands reassume a more relevant role in the workup.
METHODS
We describe 3 typical cases of patients admitted for clinically isolated syndrome and illustrate how the application of the new criteria can change the diagnostic approach with respect to the previous criteria.
RESULTS
In two of the three cases a diagnosis of multiple sclerosis is now possible.
CONCLUSIONS
The new 2017 Multiple Sclerosis criteria may have an important impact in clinical practice with an earlier treatment to avoid the risk of disease dissemination. Their application requires a careful assessment to avoid misdiagnosis and mistreatments.

Keyword

multiple sclerosis; clinically isolated syndrome; criteria; McDonald criteria; oligoclonal bands

MeSH Terms

Diagnosis
Diagnostic Errors
Humans
Multiple Sclerosis*
Oligoclonal Bands
Oligoclonal Bands

Figure

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  Fig. 1 Brain coronal plane FLAIR-weighted and axial plane T2-weighted scan showing hyperintense lesions in the left frontal lobe (A and C) and in right centrum semiovale (B and D), spinal cord sagittal and axial plane T2-weighted showing hyperintense lesions at C2 (E and G), and D1–D2 level (E and H), with enhancement on T1 post-Gadolinium scan (F).

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  Fig. 2 Brain coronal plane FLAIR-weighted scan showing hyperintense juxtacortical (A), periventricular and infratentorial lesions (B and C) without enhancement on T1 post-Gadolinium scan (F and G), axial plane T2-weighted scan showing slight signal hyperintensity in left optic nerve (E), spinal cord sagittal plane T2-weighted showing hyperintense lesions at multiple levels (D) without enhancement on T1 post-Gadolinium scan (H).

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  Fig. 3 Brain axial plane FLAIR-weighted scan showing hyperintensity of the left peritrigonal white matter (A) and coronal and axial plane FLAIR-weighted scan showing slight hyperintensity in the right optic nerve (B and C) without clear enhancement on T1 post-Gadolinium axial and sagittal scan (D, E, and F).

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