The importance of follow-up and re-diagnosis of patients with demyelinating syndrome suspicion - a case study of a conversion from radiologically isolated syndrome to clinically definite multiple sclerosis
Keywordsmagnetic resonance imaging, multiple sclerosis, oligoclonal bands, demyelinating diseases
Introduction. Radiologically isolated syndrome (RIS) is a term to describe criteria of diagnosis for the individuals, who underwent brain MRI because of other reasons than multiple sclerosis (MS) suspicion, but turned out to have white matter lesions similar to those present in patients with diagnosed MS. RIS is a separate entity with the presence of MR detected lesions strongly suggestive of MS in patients with no neurological manifestations. Although RIS is not the first stage of MS in every individual, 30-45% of them will present clinical symptoms later. There is a consensus, that about 1/3 of RIS patients will convert to clinically definite MS (CDMS) within 5 years of follow-up. There are some significant predictors of conversion, such as: age (< 37 when diagnosed), male sex and presence of lesions in spinal cord.
Case report. We describe a case of a 35-year-old female patient who was initially diagnosed with RIS after MRI performed due to migraine. After about year and a half of follow-up she presented first clinical manifestation (temporary left eye blindness) followed by second episode (in the second eye), a progression in MRI and appearance of oligoclonal bands in cerebrospinal fluid.
Discussion. Among individuals with incidentally found lesions in MRI, only few happen to have white matter findings similar to demyelinating lesions in patients with CDMS. Non-specific MRI white matter lesions are much more often than than those fulfilling 2017 MAGNIMS criteria.There is more research needed to determine significant risk factors for conversion from RIS to CDMS. In RIS patients watchful neurological supervision is indispensable.
Kulczyński M, Sapko K, Papuć E et al. Radiologically isolated syndrome - a not so rare prelude to multiple sclerosis. World Sci News. 2018;107:1-11.
Lebrun C, Kantarci OH, Siva A et al. Anomalies Characteristic of Central Nervous System Demyelination: Radiologically Isolated Syndrome. Neurol Clin. 2018 Feb;36(1):59-68. doi: 10.1016/j.ncl.2017.08.004. PMID: 29157404.
Yeh EA. Radiologically isolated syndrome in children: Can we predict future events? Neurol Neuroimmunol Neuroinflamm. 2017 Oct 23;4(6):e411. doi: 10.1212/NXI.0000000000000411. PMID: 29082298; PMCID: PMC5656405.
Yamout B, Al Khawajah M. Radiologically isolated syndrome and multiple sclerosis. Mult Scler Relat Disord. 2017 Oct;17:234-237. doi: 10.1016/j.msard.2017.08.016. Epub 2017 Aug 31. PMID: 29055465.
Makhani N, Lebrun C, Siva A et al. Radiologically isolated syndrome in children: Clinical and radiologic outcomes. Neurol Neuroimmunol Neuroinflamm. 2017 Sep 25;4(6):e395. doi: 10.1212/NXI.0000000000000395. PMID: 28959703; PMCID: PMC5614726.
Evans RW. Incidental Findings and Normal Anatomical Variants on MRI of the Brain in Adults for Primary Headaches. Headache. 2017 May;57(5):780-791. doi: 10.1111/head.13057. Epub 2017 Mar 13. PMID: 28294311.
De Stefano N, Giorgio A, Tintoré M et al. Radiologically isolated syndrome or subclinical multiple sclerosis: MAGNIMS consensus recommendations. Mult Scler. 2018 Feb;24(2):214-221. doi: 10.1177/1352458517717808. PMID: 29451440.
Yamout BI, Khoury SJ, Ayyoubi N et al. Alternative diagnoses in patients referred to specialized centers for suspected MS. Mult Scler Relat Disord. 2017 Nov;18:85-89. doi: 10.1016/j.msard.2017.09.016. Epub 2017 Sep 21. PMID: 29141828.
Klineova S, Lublin FD. Clinical Course of Multiple Sclerosis. Cold Spring Harb Perspect Med. 2018 Sep 4;8(9):a028928. doi: 10.1101/cshperspect.a028928. PMID: 29358317; PMCID: PMC6120692.
Aktas O, Wattjes MP, Stangel M et al. Diagnose der Multiplen Sklerose: Revision der McDonald-Kriterien 2017 [Diagnosis of multiple sclerosis: revision of the McDonald criteria 2017]. Nervenarzt. 2018 Dec;89(12):1344-1354. German. doi: 10.1007/s00115-018-0550-0. PMID: 29876600.
How to Cite
The periodical offers access to content in the Open Access system under the Creative Commons Attribution-NonCommercial-ShareAlike 4.0
Number of views and downloads: 180
Number of citations: 0