Pregunta 32. Cuál es el riesgo de desarrollar MS en RIS


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A 27-year-old man presents with an MRI scan of the brain “suggestive of multiple sclerosis (MS)” obtained following a motor vehicle collision. He reports persistent neck pain but has no other neurologic complaints. The patient has no history of neurologic symptoms or complaints, and results of examination are within normal limits. The patient is very concerned that he has or will get multiple sclerosis. Which of the following statements is most appropriate in response to this patient’s concerns?

A. Patients with radiologically isolated syndrome (RIS)  are not at increased risk for MS later in life.
B. Almost all patients with radiologically isolated syndrome (RIS) will be diagnosed with MS later in life.
C. Patients with radiologically isolated syndrome (RIS) and spinal cord lesions are more likely to be diagnosed with MS. **
D. The presence of gadolinium enhancement of lesions is not associated with risk development of MS.
E. Male gender, normal examination, cortical lesions are not associated with risk for developing MS
** = Your answer

The term “radiologically isolated syndrome” was first introduced in 2009 and has been used since then to describe a condition in which imaging findings are consistent with MS but there is no clinical history or examination findings to support the diagnosis. The McDonald criteria and other criteria for the radiographic diagnosis of MS do not apply in this situation, as those criteria were designed and validated in patients with clinical signs and symptoms suggestive of MS. About one third of patients with RIS will be diagnosed with MS within 5 years. Risk factors that increase that likelihood include young age (ie, <37 years) at diagnosis, male sex, cortical and/or spinal cord lesions, and gadolinium-enhancing lesions.
* Okuda DT. Incidental lesions suggesting multiple sclerosis. Continuum Lifelong Learning Neurol. 2016;22(3):730-743.

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