Acute demyelinating plaque in cervical cord

Case contributed by Chris O'Donnell
Diagnosis certain


A known case of multiple sclerosis, now acute left facial numbness and weakness of the left hand

Patient Data

Age: 40 years old
Gender: Female

Focus of T2 brightening in the upper left cord with surrounding edema and mass effect and intense ring enhancement (complete ring in the sagittal projection but incomplete on the axial). Cervical cord otherwise normal but typical demyelinating changes in the left optic nerve and periventricular white matter.

Case Discussion

This is an unusual finding of generalized demyelination in the brain and left optic nerve with a single very "inflammed" focus in the cervical cord acting as a mass lesion. Interestingly the patient presented with acute facial sensory symptoms on the left in keeping with involvement of the 5th cranial nerve nucleus that extends into the upper cervical cord to C2 (the pars caudalis).

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