Isolated demyelinating syndromes of the central nervous system
Síndromes de desmielinização isolada do sistema nervoso central
CategoryDefinition
Possible presentations of clinically isolated syndrome include optic neuritis, a brain stem and/or cerebellar syndrome, a spinal cord syndrome, or uncommonly cerebral hemispheric symptoms. Natural history studies and clinical trials of MS disease modifying therapies have shown that CIS coupled with brain MRI lesions carries a high risk for meeting diagnostic criteria for MS. Use of the 2010 revisions to the McDonald MS diagnostic criteria allows some patients with a single clinical episode to be diagnosed as MS based on the single scan criterion for dissemination in time and space. Clinically isolated syndrome is distinct from radiologically isolated syndrome (RIS), in which patients have incidental magnetic resonance image (MRI) white matter lesions in regions suggestive if demyeliantion in the absence of clinical symptoms.
Diagnostic Criteria
Signs and symptoms:
Onset of unilateral blurred vision accompanied by pain with eye movements is suggestive of optic nerve demyelination (optic neuritis). Similarly, demyelination of the spinal cord may present with symptoms depending on the level and fibres affected, a variable combination of sensory, motor and/or bladder dysfunction may be noted. Symptoms typically occur over hours or days and persists for days to weeks with variable residual disability.