Radiologically Isolated Syndrome — SCE Neurology MCQ

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ModerateMultiple Sclerosis & CNS InflammationRadiologically Isolated SyndromeSCE Neurology

A 30-year-old woman with known MS on no DMT is found to have multiple periventricular and juxtacortical lesions on a brain MRI performed for headache investigation. She has never had any neurological symptoms attributable to MS. What is this presentation classified as?

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Correct answer: B — Radiologically isolated syndrome

Radiologically isolated syndrome (RIS) describes the incidental discovery of white matter lesions highly suggestive of MS (fulfilling MRI criteria for dissemination in space) in an individual without any clinical symptoms or signs of MS. Studies show approximately 30–50% of RIS patients convert to clinically definite MS within 5–10 years. Risk factors for conversion include spinal cord lesions, positive OCBs, and age <37 years. Whether to treat RIS with DMTs is an evolving area (the ARISE and TERIS trials are informing practice). A: CIS requires a clinical event. B: PPMS requires progressive disability. D: SPMS follows RRMS. E: 'Benign MS' requires clinical disease.

Reference: MAGNIMS RIS Criteria; Thompson et al. Lancet Neurol (2018)