Radiologically isolated syndrome: an uncommon finding at a university clinic in a high-prevalence region for multiple sclerosis
The patient with RIS was a 43-year-old woman without any neurological symptoms or any history of neurological disorders except for migraine since more than 10 years. A neurological examination did not reveal any pathological findings. She had good effect of triptanes. Owing to her long history of migraine and still frequent attacks she was referred for MRI of the brain in February 2001. The scan showed 15 supratentorial T2 lesions, of which 12 were periventricular and 2 were juxtacortical. Gadolinium-enhanced sequences showed enhancement in one of the lesions. Thus three of the four of the Barkhof criteria were fulfilled. Images obtained from this patient can be seen in . Owing to the MRI findings, she was referred to a neurologist in March where a second neurological examination was normal. Cerebrospinal fluid analysis revealed oligoclonal bands and an elevated IgG index. In May she returned to the neurological clinic due to a sudden onset of intermittent bilateral symptoms in arms and hands. A new neurological examination revealed bilateral tremor and dysmetria. A new MRI in June showed three new non-enhancing supratentorial lesions. She was diagnosed with MS and at a follow-up in September the symptoms in the upper extremities had worsened. She received prednisolone treatment and was started on interferon β therapy. In November she had Lhermitte's sign and MRI showed a cervical spine lesion. Except for one occurrence of lower extremity symptoms in 2005, she has remained relapse free as of the latest neurological follow-up in March 2013.