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MS – Spinal Cord Lesion Prognosis — SCE Neurology MCQ

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ModerateMultiple Sclerosis & CNS InflammationMS – Spinal Cord Lesion PrognosisSCE Neurology

A 35-year-old man with MS asks about the prognostic significance of spinal cord lesions on MRI at diagnosis. What does the evidence show?

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Correct answer: C — The presence of spinal cord lesions at diagnosis is associated with a higher risk of disability progression and a worse long-term prognosis — they contribute to dissemination in space and predict conversion from CIS to MS

Spinal cord lesions at MS diagnosis are an independent predictor of worse long-term prognosis (faster EDSS progression, higher risk of reaching EDSS 6.0). They contribute to dissemination in space in the McDonald criteria and predict conversion from CIS to MS. Asymptomatic spinal cord lesions are also prognostically important. This has implications for treatment decisions — the presence of spinal cord lesions may support earlier high-efficacy treatment. A: They are prognostically significant. C: The opposite. D: Both brain and spinal cord lesions matter. E: Asymptomatic lesions are also important.

Reference: McDonald Criteria (2017); NICE NG100; MAGNIMS Guidelines