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Updated: Feb 17, 2026
Magnetic Resonance Imaging of Multiple Sclerosis at 7.0 Tesla
Published on: February 19, 2021
A new T2 lesion in a patient with the clinically isolated syndrome does not necessarily imply a conversion to
Fioravante Capone1, Marco Puthenparampil2, Carlo Augusto Mallio3
1Unit of Neurology, Neurophysiology, Neurobiology, Department of Medicine, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo 200, 00128 Rome, Italy; Fondazione Alberto Sordi - Research Institute for Ageing, Via Alvaro del Portillo, 5 00128 Rome, Italy.
Abstract:
In the follow-up of patients with the clinically isolated syndrome, both clinical and MRI findings should be carefully evaluated by clinicians to avoid misinterpretation and inappropriate diagnosis of multiple sclerosis. We describe a case of a patient with a previous diagnosis of clinically isolated syndrome who developed a new asymptomatic brain lesion at the MRI follow-up. The careful evaluation of clinical history and radiological findings allowed the correct diagnosis of cocaine-associated ischemic stroke. Our case highlights that, in patients with the clinically isolated syndrome, the appearance of a new lesion on MRI does not necessarily imply a conversion to multiple sclerosis. Among "better explanations", ischemic lesions are of relevance and, in patients without typical risk factors for stroke, rarer causes such as cocaine assumption should be considered.
Insights
Clinically isolated syndrome patients developing new MRI brain lesions may not have multiple sclerosis. Cocaine-associated ischemic stroke can mimic early multiple sclerosis, emphasizing careful clinical and radiological evaluation.
Area of Science:
- Neurology
- Radiology
Background:
- Clinically isolated syndrome (CIS) is often monitored for conversion to multiple sclerosis (MS).
- New brain lesions on Magnetic Resonance Imaging (MRI) are a key indicator for MS diagnosis.
Observation:
- A patient with a prior CIS diagnosis developed a new, asymptomatic brain lesion during MRI follow-up.
- Initial assessment suggested potential MS conversion.
Findings:
- Detailed clinical history and radiological review revealed the lesion was an ischemic stroke.
- The stroke was linked to cocaine use, a less common cause in patients without typical stroke risk factors.
Implications:
- New MRI lesions in CIS patients do not automatically confirm multiple sclerosis.
- Clinicians must consider alternative diagnoses, including ischemic stroke from rarer causes like substance use, when evaluating CIS patients.
- Thorough evaluation of clinical and radiological data is crucial to avoid misdiagnosis.
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