McDonald Criteria?

I am having a hard time understanding the first clinical presentation.

It says 2 or more attacks and 2 or more clinical lesions.

So, I guess my question is:
if someone has a neuro exam that shows: hyperactive reflexes, positive babinski, ataxia, positive hoffmans. And an abnormal SSEP. Does this count as 2 or more clinical lesions? and one attack?

then 30 days or more later has a dx of Optic Neuritis from an Opthalmologist. Would this then be the second attack?

Could a dx be made with only this information? I realize that most neuros do not....I just am curious if this is technically correct according to the McDonald Criteria?

[jensequitur]

Lesions are white spots showing on your MRI.  If you have an MRI with 'hyperintensity' on it, this is an active lesion.  'White matter enhancement' is your basic lesion.

What you have is evidence of dissemination in space - symptoms that are in more than one area in the body.  You also have evidence of dissemination in time - more than one documented attack of symptoms.

At this point you have a couple of choices - look for a neurologist who will diagnose you without MRI evidence, or take your chances that you will develop a lesion that will get you diagnosed.

[daisy.girl]

thanks....
I am diagnosed. I do have MRI lesions too, but just curious how this McDonald Criteria works.

I am just trying to figure this out. I am talking about clinical lesions not MRI lesions. The first McDonald Criteria says 2 attacks and 2 clinical lesions....so does what I posted meet that criteria?

[jensequitur]

A lesion is a lesion is a lesion... whether it's clinical lesions or MRI lesions, what they mean is lesions, not tests.  A 'clinical' lesion is what the radiologist says is a lesion.

[daisy.girl]

I found this when I was reading the health pages. I think written by Quix.

During the neurological exam the doctor is looking for "clinical lesions."   A clinical lesion is an abnormality on the exam that is objective evidence that there is damage in the nervous system.   Examples of "clinical lesions" are 1) hyperactive reflexes which show that there is damage in the spinal cord, 2) problems with the muscles that move the eyes indicating a problem in the brainstem, 3)  spasticity, usually also from the spinal cord,  4) positive Babinksi or Hoffman's test, and 7) paleness of the optic disc at the back of the eye.  These are just a few of many dozens that can occur.

Wish all this MS stuff was easier to understand.

[tonyad]

   Hey there :) hope your day has been good.

    Actually, a "CLinical Lesion" is not what the Radiologists is reading.  It is in fact just what it is saying..Clinical!   And Daisy Girl...you read CORRECTLY from the Health Pages!  

    It would indicate, (as mentioned in your post sbove) Some sort of an abnormality on your exam givin by your Neuro. It would indicate different lesions by objective evidence upon exam meaning that even though these lesions can not be seen by the naked eye or even sometimes......by the MRI, that there is some sort of demyelination going on in the brain / spinal cors... and a particular part if the body.

    i hope I am making sense....To sum it up.....A "Clinical Lesion" really has nothing to do w/ the Radiologist but rather objective signs that your Neuro detects when he is doing your "Clinical" exam!

     Daisy Girl.....you are right on...in your thought and understanding!
You are doing AWESOME!....And it is ALWAYS good to continue to learn as much as you can about your disease that you will be on top of the game and when seeing your Dr's or Neuro...They can not try and brush you off when you are full of CORRECT Ammunition!

    Be well my friend!
Take Care,
~Tonya

    

  

[jensequitur]

Sorry, I see what you're talking about now!

Essentially, your neuro is responsible for assessing where a clinical lesion might be.  His job is to decide what's wrong based upon the results of the tests.  But training for MS for neurologists is so inconsistent, it's hard to say which way yours will jump when the time comes.

A good neuro will base his diagnosis upon all testing and evidence, not just MRI.

> Wish all this MS stuff was easier to understand.

Yeah, I do too.  But that's why they get the big bucks!

[shoshin]

Perhaps it might be clearer to talk about clinically-detected lesions (things that show up on a clinical exam) versus a radiologically-detected lesions? They're still all lesions as Jen says.

It does sound like you have the positive evidence for MS, i.e., dissemination in time (two events 30+ days apart) and space (spine and optic nerve). As far as I know there isn't anything symptom-wise or MRI-wise that is unique to MS. So the other part of the equation is ruling out everything else that might explain your problems. If you had all the MS mimics ruled out (which is also part of the McDonald criteria), it does seem to me that you meet the criteria.

sho

[tonyad]

   She is already Diagnosed. She is just just trying to understand more and more everyday. that was the reason for the post. Not for a dx perspective but from a "Need to know More" perspective.

       I did the same thing and continue to everyday. Learn as much as I can about this Horrid Disease.

    Take Care,
~Tonya