I would like to highlight several considerations regarding application of the 2017 McDonald criteria for multiple sclerosis (MS) in the case reported by Nasser and colleagues1 in CMAJ. The authors stated that MS is “an atypical cause” of this patient’s lateral pontine syndrome (not lateral medullary syndrome, as they assert); if this were the case then caution should have been advised when applying the 2017 McDonald criteria, which are intended to be used primarily in patients with typical clinically isolated syndromes.2 A subacute focal brainstem presentation, however, is a typical clinically isolated syndrome2 and use of the 2017 McDonald criteria is therefore appropriate (the patient age of onset may be atypical for MS, but the neurologic presentation is not).
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