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1. The traditional (Posner) criteria incorporated signs and symptoms indicating 2 CNS lesions separated in time and space and not caused by other CNS disease.

2. The current McDonald criteria consider more heavily the MRI findings and have less consideration of the CSF findings than the previous (Posner) criteria.

3. T1 gadolinium MRI shows the characteristic enhancement or "plaques" of patchy myelin loss (white matter disease) with 90% sensitivity.

4. T2 weighted MRI shows MS lesions as hyperintense areas: "Dawson's fingers" refers to MS lesions around the vessels that radiate out from the ventricles.

5. 90% of MS patients have increased lgG index and oligoclonal IgG bands in the CSF.

6. CSF protein and cell count is generally normal, a small CSF lymphocytosis may be present, but should be no more than 50 cells/mm 3 .

7. Evoked action potentials (visual, brainstem auditory, and somatosensory evoked potentials) can help to establish the diagnosis of MS by identifying a clinically silent 2 nd lesion.


1. Wilkinson, I. (2017). Oxford handbook of clinical medicine. Oxford: Oxford University Press.
2. Hannaman, R. A., Bullock, L., Hatchell, C. A., & Yoffe, M. (2016). Internal medicine review core curriculum, 2017-2018. CO Springs, CO: MedStudy.
3. Image: no reference available.

Ⓒ A. Manickam 2018

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