Multiple sclerosis

Case contributed by Dr Ahmed Abd Rabou

Presentation

Female patient known to have multiple sclerosis on follow up. Recently she develop diplopia and right side parathesia

Patient Data

Age: 34 years old
Gender: Female
MRI

White matter demyelination is seen involving the left peritrigonal region and extends through the forceps major fibers and splenium of corpus callosum to the contralateral side. It displays bright signal on T2 and FLAIR, low signal on T1 and enhances after contrast giving the appearance of open ring. The bright signal on DWI is believed to be T2 shine through effect as there is no evidence of restriction on ADC map. Another two plaques are seen at the left aspects of medulla oblongata and pons. Double inversion recovery sequence DIR delineates the lesions better due to suppression of signal from the white matter and CSF. Moreover, it detects involvement of the fornix as well.

MRI

Multiple intramedullary plaques are seen involving the cord starting from C4 down to D5 vertebral level displaying bright signal on T2 and STIR. Faint enhancement is noted opposite C5-C6 level. Also the left medullary and pontine lesions are evident.

Case Discussion

Multiple sclerosis is a common demyelinating disease of the central nervous septum. The diagnosis is mainly radiological and depends on detection of white matter lesions that disseminate in time and space. Plaques can be infratentorial, deep white matter, periventricular, juxta cortical or mixed white matter-grey matter lesions. MRI is the method of choice and the newly developed sequences e.g. DIR has more role in the detection and follow up. Enhancement in MS is a sign of active inflammation and usually incomplete ring.

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Case information

rID: 32068
Case created: 11th Nov 2014
Last edited: 14th Dec 2015
Inclusion in quiz mode: Included

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