A definitive diagnosis of Multiple Sclerosis cannot be made at presentation, on patients with a *Clinically Isolated Syndrome* of the Optic Nerve, Spinal Cord or BrainStem suggestive of DeMyelination, as Dissemination in time is not established.
To determine the long-term risk of abnormalities on Brain MRI for the development of Multiple Sclerosis and Disability, we performed a 10-year follow-up on 81 such patients who had T2-weighted Brain MRI at presentation.
Initial Brain MRI was abnormal in 54 (67%). Follow up of those patients with an abnormal MRI revealed progression to Clinically Definite Multiple Sclerosis in 45 out of 54 (83%) were:
For those with a normal MRI, progression to Clinically Definite Multiple Sclerosis occurred in only three out of 27 (11%), all Benign.
There was a significant relationship between the number of lesions at presentation and both EDSS (r = 0.45, P < 0.001) and the type of disease at follow-up (P < 0.0001).
Brain MRI at presentation with a Clinically Isolated Syndrome is predictive of the long-term risk of subsequent development of Multiple Sclerosis, the type of disease and extent of Disability.