A decision analytic approach to the role of visual evoked response and cerebrospinal fluid abnormalities in the management of singular spinal sclerosis.

With the use of Bayesian decision analytic techniques we assess the role of visual evoked response (VER) and cerebrospinal fluid (CSF) examinations in the investigation of patients with suspected singular spinal sclerosis. An abnormal VER increases the probability of multiple sclerosis by 50%. An associated CSF abnormality does not affect this probability. In a setting of a negative VER, CSF abnormalities increase the probability of multiple sclerosis by 27%. On currently available data, VER should therefore be the primary investigation in patients with suspected singular spinal sclerosis. If the result is abnormal myelography may be omitted. CSF examinations are only useful if VER facilities are not available.