Abstract
The incidental evidence of white matter (WM) T2-hyperintense lesions on brain magnetic resonance imaging (MRI) is a clinical challenge. In a small subset of asymptomatic patients (less than 1%), lesions morphology and distribution are highly suggestive of multiple sclerosis (MS), hence meeting the disease dissemination in space criteria for the diagnosis of radiologically isolated syndrome (RIS). Conversely, in patients at first neurological presentation (clinically isolated syndrome [CIS]), prompt recognition of typical MS features and a correct application of McDonald criteria is fundamental for early diagnosis, and consequent disease-modifying treatments start.
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