Highlights from

AAN 2019

American Academy of Neurology annual meeting

Philadelphia, USA 4-10 May 2019

McDonald Criteria MS often misapplied and misunderstood

Neurology residents and, to a lesser degree, MS specialists from the USA and Canada often incorrectly apply core components of the McDonald diagnostic criteria for MS [1]. Researchers suggest education may reduce misdiagnosis by concentrating on misinterpreted and misapplied components of the criteria.

A web-based survey was designed in which 72 neurology residents and 88 MS specialists from the USA and Canada partook. MS atypical syndromes that were incorrectly identified as typical by residents and MS specialists, respectively, were complete transverse myelopathy (by 35% and 15%); intractable vomiting/nausea/hiccups (20% and 5%); and bilateral optic neuritis/unilateral optic neuritis with poor visual recovery (17% and 10%). “Touch or abutting” the ventricle criterion for periventricular lesions was correctly identified by 38% of residents and 61% of MS specialists; “juxtacortical” by 19% and 54%. Optic nerve involvement was incorrectly seen as a region that fulfils the criterion of MRI dissemination in space by 31% of residents and 26% of MS specialists. Subcortical white matter was incorrectly identified as a region that fulfils MRI dissemination in space by 11% and 18%. A case of radiologically isolated syndrome (RIS) was incorrectly identified as justifying the diagnosis MS by 48% and 12%. Nonspecific historical visual symptoms were incorrectly seen as fulfilling the criterion of dissemination in time by 75% of residents and 49% of MS specialists. Non-specific historical sensory and coordination symptoms were considered to fulfil dissemination in time by 88% and 65%.

  1. Solomon A, et al. AA 2019, S6.001.

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