Sorry I missed this post. So you have a CIS with monosymptomatic presentation. You had one attack and one clinical lesion. Whether you fulfill the Criteria for Definite MS depends on the location and number of your lesions. I don't know the timeline (duration) from direct axonal damage to "Black Hole." But, the McDonald Criteria do not address the whole "Black Hole" issue at all. They are never mentioned.

A good neuro will set aside the stringent requirements of the Criteria and use his brain to see the whole picture. This is where I become so angry at either lazy or wishy-washy neuro's who do not attempt to put it all together. If you are being treated as a CIS, but actually are a Definite then there is no harm. Your treatment is pretty much the same. However, the visible black holes indicate you have some real progression in your disease. They represent brain loss - get enough of them and the brain will contract around them and you will have significant brain atrophy.

In putting this together I would think your neuro would want to be an the agressive side was far as watching and treating, but actually I don't know for sure. On my other forum we currently have three or four people with significant brain alterations (lesions), but few or no symptoms. I have not see a good description of how these people are treated or what the recommendations are. And I was not a neurologist in my prior life.

Again the whole neuro field of clinical treatment (as opposed to the research part) usually act as though the T2 lesion represents the sum total of our disease, when gads of research is showing that it is only a portion. It is the portion that seems to correspond to our RRMS the best, but not to the accrual of disability that runs along in so many of us.

Quix