Research Article
Clinically and Radiological isolated syndrome (MS risk)
Hassan Ahmed Hashem*, Yasser Hamed Mustafa, Abdelazim M Reda, Sameh Azab and Ahmed M Solaiman
Published: 07/28/2018 | Volume 2 - Issue 2 | Pages: 041-046
Abstract
Background: The use of brain magnetic resonance imaging (MRI) for evaluation of neurological disorders has increased in the past two decades. This has led to an increased detection of incidental findings on brain MRI.The most common of these asymptomatic abnormalities are white matter lesions that are interpreted as demyelinating based on radiological criteria. However, in the absence of associated clinical symptoms suggestive of multiple sclerosis (MS), a definite diagnosis of MS can’t be made in patients with these incidental white matter lesions. These patients are diagnosed as CIS (clinically isolated syndrome) and RIS (radiologically isolated syndrome).Using the revised McDonald criteria now allows some patients who would have been diagnosed with CIS to be diagnosed as having MS before a second episode.
Method: Sixty one patients, 40 females and 21 males, age ranged between 15 years and 58 years, were included in our study. In addition to a detailed medical and neurological history and examination, CSF and blood analysis for oligoclonal bands and IgG index were performed for all patients.
Result: 41 patients had positive oligoclonal bands and IgG index. After clinical, MRI results and laboratory results 44 (72.1%) were diagnosed CIS and 17 (27.9%) were RIS.
Conclusion: Diagnosis of MS not depend only on MRI finding but need clinical and laboratory work up including CSF and blood analysis for oligoclonal bands and IgG index to confirm diagnosis.
Read Full Article HTML DOI: 10.29328/journal.jro.1001020 Cite this Article
References
- Leahy H, Garg N. Radiologically Isolated Syndrome: An Overview Neurol. 2013; 5: 22-26. Ref.: https://tinyurl.com/ycly3ta7
- Polman CH, Reingold SC, Banwell B, Clanet M, Cohen JA, et al. Diagnostic criteria for multiple sclerosis: 2010 revisions to the McDonald criteria. Ann Neurol. 2011; 69: 292-302. Ref.: https://tinyurl.com/y9vt4n2h
- Chard DT, Dalton CM, Swanton J, Fisniku LK, Miszkiel KA, et al. MRI only conversion to multiple sclerosis following a clinically isolated syndrome. J Neurol Neurosurg Psychiatry. 2011; 82: 176-179. Ref.: https://tinyurl.com/ydh8p929
- Thompson AJ, Banwell BL, Barkhof F, Carroll WM, Coetzee T, et al. Diagnosis of multiple sclerosis: 2017 revisions of the McDonald criteria. Lancet Neurol. 2018; 17: 162-173. Ref.: https://tinyurl.com/yblx28l8
- Masjuan J, Alvarez-Cermeno JC, Garcia-Barragan N, Díaz-Sánchez M, Espiño M, et al. Clinically isolated syndromes: a new oligoclonal band test accurately predicts conversion to MS. Neurology. 2006; 66: 576-578. Ref.: https://tinyurl.com/y7hjfude
- Sellner J, Schirmer L, Hemmer B, Mühlau M. The radiologically isolated syndrome: take action when the unexpected is uncovered. J Neurol. 2010; 257: 1602-1611. Ref.: https://tinyurl.com/ydy3sydo
- Miller DH, Chard DT, Ciccarelli O. Clinically isolated syndromes. Lancet Neurol. 2012; 11: 157-169. Ref.: https://tinyurl.com/yb967rg7
- Liu S, Kullnat J, Bourdette D, Simon J, Kraemer DF, et al. Prevalence of brain magnetic resonance imaging meeting Barkhof and McDonald criteria for dissemination in space among headache patients. Mult Scler. 2013; 19: 1101-1115. Ref.: https://tinyurl.com/y6wubu7v
- Polman CH, Reingold SC, Edan G, Filippi M, Hartung HP, et al. Diagnostic criteria for multiple sclerosis: 2005 revisions to the “McDonald Criteria”. Ann Neurol. 2005; 58: 840-846. Ref.: https://tinyurl.com/y7tfpuzn
- Okuda DT, Mowry EM, Beheshtian A, Waubant E, Baranzini SE, et al. Incidental MRI anomalies suggestive of multiple sclerosis: the radiologically isolated syndrome. Neurology. 2009; 72: 800-805. Ref.: https://tinyurl.com/y95weesd
- Amato MP, Hakiki B, Goretti B, Rossi F, Stromillo ML, et al . Association of MRI metrics and cognitive impairment in radiologically isolated syndromes. Neurology. 2012; 78: 309-314. Ref.: https://tinyurl.com/ydesg9bo
- Stromillo ML, Giorgio A, Rossi F, Battaglini M, Hakiki B, et al. Brain metabolic changes suggestive of axonal damage in radiologically isolated syndrome. Neurology. 2013; 80: 2090-2094. Ref.: https://tinyurl.com/yavdsygg
- Miller DH, Chard DT, Ciccarelli O. Clinically isolated syndromes. Lancet Neurol. 2012; 11: 157-169. Ref.: https://tinyurl.com/yb967rg7
- Alonso A, Hernán MA. Temporal trends in the incidence of multiple sclerosis: a systematic review (review). Neurology. 2008; 71: 129-135. Ref.: https://tinyurl.com/yd34lrfw
- Koch-Henriksen N, Sørensen PS. The changing demographic pattern of multiple sclerosis epidemiology (review). Lancet Neurol. 2010; 9: 520-532. Ref.: https://tinyurl.com/ya3n57el
- Confavreux C, Vukusic S. Natural history of multiple sclerosis: a unifying concept. Brain. 2006; 129: 606-616. Ref.: https://tinyurl.com/yd2ksepd
- Miller D, Barkhof F, Montalban X, Thompson A, Filippi M. Clinically isolated syndromes suggestive of multiple sclerosis, part II: non-conventional MRI, recovery processes, and management. Lancet Neurol. 2005; 4: 341-348. Ref.: https://tinyurl.com/ybo6ty75
- Miller D, Barkhof F, Montalban X, Thompson A, Filippi M. Clinically isolated syndromes suggestive of multiple sclerosis, part I: natural history, pathogenesis, diagnosis, and prognosis. Lancet Neurol. 2005; 4: 281-288. Ref.: https://tinyurl.com/ycsj39mm
- Awad A, Hemmer B, Hartung HP, Kieseier B, Bennett JL, et al. Analyses of cerebrospinal fluid in the diagnosis and monitoring of multiple sclerosis. J Neuroimmunol. 2010; 219: 1-7. Ref.: https://tinyurl.com/yd7eq7d3
- Zipoli V, Hakiki B, Portaccio E, Lolli F, Siracusa G, et al. The contribution of cerebrospinal fluid oligoclonal bands to the early diagnosis of multiple sclerosis. Mult Scler. 2009; 15: 472-478. Ref.: https://tinyurl.com/y93ctf87
- Paolino E, Fainardi E, Ruppi P, Tola MR, Govoni V, et al. A prospective study on the predictive value of CSF oligoclonal bands and MRI in acute isolated neurological syndromes for subsequent progression to multiple sclerosis. J Neurol Neurosurg Psychiatry. 1996; 60: 572-575. Ref.: https://tinyurl.com/y99ot95u
- Sastre-Garriga J, Tintore M, Rovira A, Grivé E, Pericot I, et al. Conversion to multiple sclerosis after a clinically isolated syndrome of the brainstem: cranial magnetic resonance imaging, cerebrospinal fluid and neurophysiological findings. Mult Scler. 2003; 9: 39-43. Ref.: https://tinyurl.com/y9poolcx
- Tintore M, Rovira A, Brieva L, Grivé E, Jardí R, et al. Isolated demyelinating syndromes: comparison of CSF oligoclonal bands and different MR imaging criteria to predict conversion to CDMS. Mult Scler. 2001; 7: 359-363. Ref.: https://tinyurl.com/y9weq69j
- Avasarala JR, Cross AH, Trotter JL. Oligoclonal band number as a marker for prognosis in multiple sclerosis. Arch Neurol. 2001; 58: 2044-2045. Ref.: https://tinyurl.com/ycy9nq84
- Sellner J, Schirmer L, Hemmer B, Mühlau M. The radiologically isolated syndrome: take action when the unexpected is uncovered? J Neurol. 2010; 257: 1602-1611. Ref.: https://tinyurl.com/ydy3sydo
- Schwenkenbecher P, Sarikidi A, Bönig L, Wurster U, Bronzlik P, et al. Clinically Isolated Syndrome According to McDonald 2010: Intrathecal IgG Synthesis Still Predictive for Conversion to Multiple Sclerosis. Int J Mol Sci. 2017; 18: 2061. Ref.: https://tinyurl.com/yc4cd9dk
- Schaffler N, Kopke S, Winkler L, Schippling S, Inglese M, et al. Accuracy of diagnostic tests in multiple sclerosis--a systematic review. Acta Neurol Scand. 2011; 124: 151-164. Ref.: https://tinyurl.com/y8fekjsb
- Balcer LJ. Clinical practice. Optic neuritis. N Engl J Med. 2006; 354: 1273-1280. Ref.: https://tinyurl.com/y92orlma
- Granberg T, Martola J, KristoffersenâWiberg M, Aspelin P, Fredrikson S. Radiologically isolated syndrome–incidental magnetic resonance imaging findings suggestive of multiple sclerosis, a systematic review. Mult Scler. 2013; 19: 271-280. Ref.: https://tinyurl.com/ybgwowma