Clinically isolated syndrome (CIS) is the first clinical episode of demyelination that is possibly due to multiple sclerosis. In most patients who have an abnormal MRI, it represents the precursor to multiple sclerosis.
Such attacks can be due to one or more demyelinating lesions at the same time 1,2. Typical presentations include optic neuritis, a brainstem or cerebellar syndrome (such as internuclear ophthalmoplegia, ataxia, or vertigo), and incomplete transverse myelitis.
Under the latest McDonald criteria (2017), a patient with a clinically isolated syndrome need additional data to establish a diagnosis of multiple sclerosis. If the attack is multifocal (more than one lesion has objective clinical evidence), then the presence of dissemination in time on MRI or CSF-specific oligoclonal bands would diagnose multiple sclerosis. If the attack is unifocal (one lesion has objective clinical evidence), then the presence of dissemination in space on MRI and either dissemination in time on MRI or CSF-specific oligoclonal bands would diagnose multiple sclerosis.
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