Transformation of Radiologically Isolated Syndrome into Tumefactive Multiple Sclerosis

Diagnosing Multiple Sclerosis (MS) is challenging because of many diseases can be confused with it. MRI helps neurologists to do a right diagnosis of MS fulfilling the dissemination in space and time criteria (2017 McDonald criteria) and there must be no other explanation for the patient's symptoms. However, with the increasing MRI availability, there has also been an increase in abnormal incidental radiological findings so close to the typical MS lesions, but these patients have no signs or symptoms of the disease; this entity is named Radiologically Isolated Syndrome (RIS). It is very important to know these RIS patients are at high risk of developing MS, although there are no approved treatments for this asymptomatic phase of the disease. Here we are reporting a clinical case showing the RIS concept and how the patient has developed a tumefactive MS in the early time course of the disease. We suggest that onset early treatment in this presymptomatic phase is a good clinical practice to prevent a new relapse of MS.