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Neurology
Published in Shibley Rahman, Avinash Sharma, A Complete MRCP(UK) Parts 1 and 2 Written Examination Revision Guide, 2018
Shibley Rahman, Avinash Sharma
A new system of classification, the ‘McDonald criteria’, incorporates clinical and laboratory elements, allowing an earlier confirmation of the diagnosis and thus enabling earlier decisions about starting disease-modifying therapies. Therefore, in summary, multiple sclerosis is now a clinical diagnosis on the basis of two episodes involving two or more areas of the central nervous system over time, but the McDonald criteria incorporate magnetic resonance imaging to demonstrate multiple areas of involvement and also involvement over time with the appearance of new enhancing lesions.
Demyelinating syndrome
Published in Michael Y. Wang, Andrea L. Strayer, Odette A. Harris, Cathy M. Rosenberg, Praveen V. Mummaneni, Handbook of Neurosurgery, Neurology, and Spinal Medicine for Nurses and Advanced Practice Health Professionals, 2017
Jeffrey Hernandez, Leticia Tornes, Janice Y. Maldonado
To establish a diagnosis of MS, lesions in the CNS must be separated both in time and space. The 2010 Revised McDonald Criteria include a simplified iteration of MRI requirements to establish the diagnosis of MS or CIS, allowing identification of MS with high probability at its first clinical manifestation (Polman et al., 2011). Lesions in MS will most commonly be in the periventricular white matter, brainstem, cerebellum, and spinal cord with highly specific lesions found in the corpus callosum and ovoid lesions perpendicular to the ventricles, named Dawson fingers (Figure 67.1). Importantly, the diagnosis of MS rests on ruling out other disorders that may have similar clinical presentations.
Central nervous system
Published in David A Lisle, Imaging for Students, 2012
Because of the importance of achieving a correct diagnosis in young adults, diagnostic criteria have been developed. Known as the ‘McDonald criteria’, these were released in 2001 and revised in 2005. The McDonald criteria incorporate a combination of clinical factors, CSF findings (oligoclonal IgG bands) and MRI appearances to diagnose MS.
Intermediate Uveitis: A Review
Published in Ocular Immunology and Inflammation, 2023
Andrea York Tiang Teo, Bjorn Kaijun Betzler, Keith Low Qie Hua, Elizabeth Jiahui Chen, Vishali Gupta, Rupesh Agrawal
The most notable systemic diseases associated with IU are sarcoidosis and multiple sclerosis. Table 2 summarizes the prevalence of IU associated with systemic disease by country. Though more commonly associated with anterior uveitis, IU is estimated to account for a quarter of patients with sarcoid uveitis.130 The SUN Working Group has recently developed classification criteria for 25 of the most common uveitides, including sarcoidosis- and multiple sclerosis-associated uveitis. Patients with sarcoidosis-associated IU typically have bilateral chronic manifestation and present more commonly with vitreous inflammation, snowballs, and string of pearls inflammatory debris, though the absence of pars planitis cannot exclude the diagnosis of sarcoidosis-associated uveitis.131 Patients with multiple sclerosis-associated IU often present with pars plana snowbanks and peripheral retinal vascular sheathing or leakage, and may also have vitreous cells or vitreous haze or both.132 Diagnosis of multiple sclerosis is guided by the 2017 McDonald Criteria.133
Experiences of receiving a diagnosis of multiple sclerosis: a meta-synthesis of qualitative studies
Published in Disability and Rehabilitation, 2023
Gogem Topcu, Jacqueline R. Mhizha-Murira, Holly Griffiths, Clare Bale, Avril Drummond, Deborah Fitzsimmons, Kristy-Jane Potter, Nikos Evangelou, Roshan das Nair
Multiple Sclerosis (MS) is one of the most common diseases of the central nervous system among young adults, affecting around 2.8 million people worldwide [1]. The diagnostic process can be arduous and complicated due to the variable nature of MS and the lack of a single diagnostic test to confirm it. The lack of a precise and specific MS biomarker also makes the process of reaching a definitive diagnosis challenging [2,3]. There are also a number of conditions that can result in multifocal involvement of the brain and spinal cord, mimicking MS [4] and causing difficulties in confirming the diagnosis. The 2017 McDonald criteria for MS diagnosis combines clinical, imaging and laboratory evidence to make a reliable diagnosis of MS [5]. However, the McDonald criteria are often misunderstood and misapplied [6], resulting in a lengthy and complex diagnosis process. Consequently, the period surrounding diagnosis in MS can be psychologically demanding, causing distress, confusion and frustration to people with MS and their families [7–10]. The experience of being diagnosed with MS and the way in which this diagnostic phase is managed may influence the individual’s future perceptions about MS, and the nature and quality of their relationships with healthcare professionals [8,11]. Therefore, support around this challenging and confusing period is important.
Beyond McDonald: updated perspectives on MRI diagnosis of multiple sclerosis
Published in Expert Review of Neurotherapeutics, 2021
The consequence of the simplification of the 2017 diagnostic criteria was an increase in sensitivity in the short term but a slight decrease in specificity in predicting a second clinical attack in comparison to previous criteria, albeit with no significant differences in overall accuracy [29]. Although, this last version of the McDonald criteria integrates issues relating to MS misdiagnosis and incorporate specific recommendations for its prevention, the interpretation of clinical and MRI assessments upon which these criteria depend will continue to allow misdiagnoses [30]. Additionally, the progressively higher sensitivity of the McDonald criteria has allowed the diagnosis of MS in patients with a more benign disease course with a significant reduction in the proportion of patients reaching a certain degree of disability at follow-up [31]. This can be explained, at least partially, by the so-called ‘Will Rogers’ phenomenon, an epidemiological paradox in which changes in prognosis are explained by the use of criteria with higher sensitivity [32]. According to this phenomenon, more patients initially diagnosed with CIS will convert faster into MS based on the fulfillment of the less restrictive criteria for both DIS and DIT and consequently will have a better outcome [32]. In fact, the proportion of CIS patients diagnosed with MS after long follow-up periods is not different among the different versions of the McDonald criteria and the Poser criteria [31].