Table 2.

Neurological signs and symptoms in siblings affected by IU and/or MS

Patient	Age of onset (y/o) of neurological symptoms	Neurological symptoms	Neurological findings	MRI findings	Neurological Dx	Treatment
M-XY EMU003	–	–	–	–	None. Patient died in an accident before knowing if he had MS findings.	Observation.
M-XY EMU004	17	Fatigue in lower limbs. Anxiety.	–	Refuses to diagnose confirmation.	Neurological symptoms suggesting MS comorbidity Fatigue syndrome in lower limbs. Generalized anxiety syndrome (psychiatric diagnosis).	Systemic corticosteroids, prednisolone, and systemic immunosuppressant, methotrexate.
F-XX EMU005	22	Decrease strength and sensitivity of the body right half. Decrease in sensation of the right upper limb.	Right Babinski (+). Right pyramidal motor syndrome. Right hypoesthesia. Hemiparetic gait. Hypoesthesia of the right upper limb. Left hemiparesis. Strength 3/5. Left hypoesthesia.	22-year-old brain MRI: Small punctate lesions in the white matter of semi-oval centers of both hemispheres. Spine MRI (cervical): punctate focal lesion of the cord at C3 level without signs of inflammatory activity. 27-year-old brain MRI: multiple periventricular lesions, two of them have enhancement with contrast medium indicating activity. Spine MRI: presence of cervical and thoracic demyelinating plaques. 33-year-old brain MRI: 10 new lesions and volume loss of the cerebral parenchyma. Spine MRI (cervical): The lesions described are more confluent and are associated with a discrete decrease in the volume of the cord.	Multiple sclerosis 2017 McDonald criteria: ≥ 2 attacks and objective clinical evidence of ≥ 2 lesions. CSF-specific oligoclonal bands	Systemic corticosteroids, prednisolone, and systemic immunosuppressant, methotrexate.
F-XX EMU002	19	Alteration of balance. Paresthesia in hands and head. Urine retention.	Romberg +. Dysdiadochokinesia. Neurogenic bladder.	Previous images not available. 32-year-old brain MRI: multiple supra and infratentorial hyperintense lesions in T2 and FLAIR sequence. Presence of black holes and active lesions. Spine MRI (cervical): hyperintense cervical and dorsal lesions. Atrophy of the medullary cord. No active lesions.	Multiple sclerosis 2017 McDonald criteria: ≥ 2 attacks and objective clinical evidence of ≥ 2 lesions. CSF-specific oligoclonal bands	Systemic corticosteroids, prednisolone, and systemic immunosuppressants, methotrexate.

MRI magnetic resonance imaging