Table 2.
Clinical features of CIS and likelihood of signaling an MS diagnosis (6)
| CIS features typically seen in MS | Less common CIS features that 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 Uveitis (mild, posterior) | Neuroretinitis (optic disc swelling with macular star) Uveitis (severe, anterior) |
|
| ||
| Brain stem/cerebellum | ||
| Bilateral internuclear ophthalmoplegia | Unilateral internuclear ophthalmoplegia, facial palsy, facial myokmia | Complete external ophthmalmoplegia; 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 Paroxysmal tonic spasms |
Progressive trigeminal sensory neuropathy Focal dystonia, torticollis |
|
| ||
| Spinal cord | ||
| Partial myelopathy | Complete transverse myelitis | Anterior spinal artery territory lesion (sparing posterior columns only) |
| Lhermitte’s symptom Deafferented hand | Radiculopathy, areflexia Segmental loss of pain and temperature sensation | Cauda equina syndrome |
| Numbness | Partial Brown–Sequard syndrome (sparing posterior colums) | Sharp sensory level to all modalities and localized spinal pain |
| Urinary urgency, incontinence, erectile dysfunction | Fecal incontinence | Complete Brown–Sequard syndrome |
| Progressive spastic paraplegia (asymmetrical) | Progressive spastic paraplegia (symmetrical) | Acute urinary retention Progressive sensory ataxia (posterior columns) |
|
| ||
| Celebral hemispheres | ||
| Mild subcortical cognitive impairment | Epilepsy | Encephalopathy (obtundation, confusion, drowsiness)a |
| Hemiparesis | Hemianopia | Cortical blindness |
a
Although encephalopathy is required for ADEM, it may also be seen at presentation and/or during the course of MS.
CIS: clinically isolated syndrome; MS: multiple sclerosis