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    Revised McDonald Criteria for Multiple Sclerosis Diagnosis

    Determines presence of MS using MRI findings.

    The 2010 Revised McDonald Criteria is seen as the gold standard of MS diagnosis, and uses MRI data to aid in diagnosis.

    Primary Criteria

    Diagnostic Result:

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    The 2010 McDonald Criteria for Diagnosis of MS

    Clinical Presentation Additional Data Needed for MS Diagnosis
    ∙Two or more attacks
    ∙Objective clinical evidence of 2 or more lesions with reasonable historical evidence of a prior attack
    None; clinical evidence will suffice
    Additional evidence (eg, brain MRI) desirable, but must be consistent with MS
    ∙Two or more attacks
    ∙Objective clinical evidence of 1 lesion
    Dissemination in space demonstrated by MRI
    Await further clinical attack implicating a different site
    ∙One attack
    ∙Objective clinical evidence of 2 or more lesions
    Dissemination in time demonstrated by MRI
    second clinical attack
    ∙One attack
    ∙Objective clinical evidence of 1 lesion (clinically isolated syndrome)
    Dissemination in space demonstrated by MRI
    Await a second clinical attack implicating a different CNS site
    Dissemination in time, demonstrated by MRI or second clinical attack
    ∙Insidious neurologic progression suggestive of MS One year of disease progression and dissemination in space
    One or more T2 lesions in brain, in regions characteristic of MS
    Two or more T2 focal lesions in spinal cord Positive CSF
    Notes: An attack is defined as a neurologic disturbance of the kind seen in MS.
    It can be documented by subjective report or by objective observation, but it must last for at least 24 hours.
    Pseudoattacks and single paroxysmal episodes must be excluded.
    To be considered separate attacks, at least 30 days must elapse between onset of one event and onset of another event.


    The Revised McDonald Criteria also includes diagnosis of Primary progressive multiple sclerosis (PPMS). Positive if:

    • ≥1 year of disease progression (this can be determined either prospectively or retrospectively)
    • Plus two of the following three criteria
      • Brain dissemination in space ( ≥1 T2 bright lesions in ≥1 of juxtacortical, periventricular, infratentorial areas)
      • Spinal cord dissemination in space (≥2 T2 bright lesions)
      • Positive CSF (oligoclonal bands and/or elevated IgG index)


    Dr. Christopher H. Polman

    About the Creator

    Christopher H. Polman, MD, is a professor and head of the neurology department at Vrije University (VU) in the Netherlands. He was appointed to the executive board of VU Medical Center. Dr. Polman has published over 250 papers since 2005 with a primary research focus on multiple sclerosis (MS) diagnosis and treatment.

    To view Dr. Christopher H. Polman's publications, visit PubMed