It is very important to remember the following clarification:-
"Alternative diagnoses must be considered. There must be no better explanation for the clinical picture"
A typical MS plaque of demyelination in the spinal cord
MS is a disease of the "white matter"
What is White Matter?
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Table text in simple text form:
Diagnostic Criteria
Clinical Presentation Additional Data Needed for DiagnosisTwo or more attacks; objective clinical evidence of 2 ormore lesionsNoneTwo or more attacks; objective clinical evidence of 1 lesion Dissemination in space, demonstrated byMRIorTwo or more MRI-detected lesions consistent with multiple scleosisplus positive CSForAwait further clinical attack implicating a different siteOne attack; objective clinical evidence of 2 or more lesions Dissemination in time, demonstrated byMRIorSecond clinical attackOne attack; objective clinical evidence of 1 lesion (monosymptomaticpresentation; clinically isolated syndrome)Dissemination in space, demonstrated byMRIorTwo or more MRI-detected lesions consistent with MS pluspositive CSFandDissemination in time, demonstrated byMRIorSecond clinical attackInsidious neurological progression suggestive of multiple sclerosis Positive CSFandDissemination in space, demonstrated by1) Nine or more T2 lesions in brain or 2) 2 or more lesionsin spinal cord, or 3) 4–8 brain plus 1 spinal cord lesionorabnormal VEP associated with 4–8 brain lesions, or withfewer than 4 brain lesions plus 1 spinal cord lesion demonstratedby MRIandDissemination in time, demonstrated byMRIorContinued progression for 1 yearIf criteria indicated are fulfilled, the diagnosis is made; if the criteria are not completely met, the diagnosis is “possible”;if the criteria are fully explored and not met, the diagnosis is “not made.”No additional tests are required; however, if tests [magnetic resonance imaging (MRI), cerebral spinal fluid (CSF)] are undertaken and arenegative, extreme caution should be taken before making a diagnosis of this condition. Alternative diagnoses must be considered. There must be no betterexplanation for the clinical picture.MRI demonstration of space dissemination must fulfill the criteria derived from Barkhof et and Tintore´ et al (see Table 1).Positive CSF determined by oligoclonal bands detected by established methods (preferably isoelectric focusing) different from any such bandsin serum or by a raised IgG index.14,15MRI demonstration of time dissemination must fulfill the criteria listed in Table 2.Abnormal visual evoked potential of the type seen in this condition (delay with a well-preserved wave form).
