Skip to navigation Skip to content

Clinically Isolated Syndrome

Share

Overview

Clinically isolated syndrome (CIS) is a term that describes a first clinical episode of a disease that shows characteristics of inflammatory demyelination that could be MS but has yet to fulfill criteria of dissemination in time (Lublin et al., 2014). It usually occurs in young adults and affects optic nerves, the brainstem, or the spinal cord. Although patients usually recover from their presenting episode, CIS is often the first manifestation of MS.

The most common CIS presentations and risk factors for Clinically Definite MS (Brownlee and Miller, 2014) include:

Optic Neuritis

  • Unilateral reduced visual acuity
  • Orbital pain particularly with eye movement
  • Reduced color vision
  • Afferent pupillary defect
  • Retrobulbar or mild disc swelling

Brainstem

  • Bilateral internuclear ophthalmoplegia
  • Ataxia and gaze evoked nystagmus
  • 6th nerve palsy
  • Multi-focal symptoms
  • Facial sensory loss
  • Vertigo
  • Ataxia
  • Dysarthria

Spinal cord

  • Incomplete transverse myelitis
  • Positive Lhermitte’s sign
  • Sphincter symptoms
  • Asymmetric limb weakness
  • Symptom progression between 4 hours and 21 days.

Risk factors

The important risk factors for the conversion to clinically definite MS (CDMS) are:

Treatment of CIS

  • High-dose glucocorticoids for acute symptoms
  • Some disease-modifying treatments have an FDA indication to  delay the conversion of CIS to MS (Miller et al., 2012)

Share