Presentation
Follow up of known multiple sclerosis. Recent onset diplopia and right sided parasthesia.
Patient Data
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.
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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