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Radiologically isolated syndrome: a practical guide

Audrey Reynolds1,2, Rory O'Donohoe2,3, Chris McGuigan4,2

  • 1Neurology, St Vincent's University Hospital, Dublin, Ireland reynolau@tcd.ie.

Practical Neurology
|October 29, 2025
PubMed

Insights

Radiologically isolated syndrome (RIS) is an incidental MRI finding of demyelination without symptoms. This review covers RIS diagnosis, management, and therapies, including how updated 2024 McDonald criteria impact patient care.

Area of Science:

  • Neurology
  • Radiology
  • Demyelinating Diseases

Background:

  • Radiologically isolated syndrome (RIS) presents as incidental MRI evidence of demyelination.
  • Patients with RIS lack clinical signs or symptoms of neurological disease.
  • Managing RIS poses challenges for neurologists due to its asymptomatic nature.

Purpose of the Study:

  • To provide a comprehensive overview of radiologically isolated syndrome (RIS).
  • To discuss the diagnostic and misdiagnostic challenges associated with RIS.
  • To outline current approaches to managing suspected RIS cases and explore potential therapies.

Main Methods:

  • Literature review on radiologically isolated syndrome (RIS).
  • Analysis of diagnostic criteria, including the updated 2024 McDonald criteria.
  • Discussion of clinical management strategies and therapeutic options for RIS.

Main Results:

  • RIS diagnosis relies on identifying demyelinating lesions on MRI in asymptomatic individuals.
  • The 2024 McDonald criteria may alter the diagnostic and management pathways for some RIS patients.
  • Effective management strategies and emerging therapies are crucial for addressing RIS.

Conclusions:

  • RIS requires careful diagnostic evaluation to differentiate from other conditions.
  • Updated diagnostic criteria influence the approach to RIS management.
  • Further research into therapies is needed to improve outcomes for individuals with RIS.
Keywords:
MULTIPLE SCLEROSISNEUROIMMUNOLOGYNEURORADIOLOGY

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