Table 3.
CIS clinical features and likelihood of signaling an MS diagnosis
| CIS features typically seen in MS | Less common CIS features which may be seen in MS | Atypical CIS features not expected in MS |
| Optic nerve | ||
| Unilateral optic neuritis | Bilateral simultaneous optic neuritis | Progressive optic neuropathy |
| Pain on eye movement | No pain | Severe, continuous orbital pain |
| Partial and mainly central visual blurring | No light perception | Persistent complete loss of vision |
| Normal disc or mild disc swelling | Moderate to severe disc swelling with no hemorrhages | Neuroretinitis (optic disc swelling with macular star) |
| Uveitis (mild, posterior) | Uveitis (severe, anterior) | |
| Brain stem/cerebellum | ||
| Bilateral internuclear ophthalmoplegia | Unilateral internuclear ophthalmoplegia, facial palsy, facial myokymia | Complete external ophthalmoplegia; vertical gaze palsies |
| Ataxia and multidirectional nystagmus | Deafness | Vascular territory syndrome, e.g., lateral medullary |
| Sixth nerve palsy | One-and-a-half syndrome | Third nerve palsy |
| Facial numbness | Trigeminal neuralgia | Progressive trigeminal sensory neuropathy |
| Paroxysmal tonic spasms | Focal dystonia, torticollis | |
| Spinal cord | ||
| Partial myelopathy | Complete transverse myelitis | Anterior spinal artery territory lesion (sparing posterior columns only) |
| Lhermitte's symptom | Radiculopathy, areflexia | Cauda equina syndrome |
| Deafferented hand | Segmental loss of pain and temperature sensation | Sharp sensory level to all modalities and localized spinal pain |
| Numbness | Partial Brown-Sequard syndrome (sparing posterior columns) | Complete Brown-Sequard syndrome |
| Urinary urgency, incontinence, erectile dysfunction | Faecal incontinence | Acute urinary retention |
| Progressive spastic paraplegia (asymmetrical) | Progressive spastic paraplegia (symmetrical) | Progressive sensory ataxia (posterior columns) |
| Cerebral hemispheres | ||
| Mild subcortical cognitive impairment | Epilepsy | Encephalopathy (obtundation, confusion, drowsiness)a |
| Hemiparesis | Hemianopia | Cortical blindness |
aAlthough encephalopathy is required for ADEM, it may also be seen at presentation and/or during the course of MS.