Presentation
55-year-old female patient presents with 4 weeks history of left leg numbness. Gradual onset. Also reduced perianal sensation, diffuse and reduced sensation and brisk reflexes in all 4 limbs. Hoffman's positive bilaterally.
Patient Data
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Multiple infra and supratentorial white matter hyperintensities have a predominantly periventricular distribution, also involving the callososeptal interface, with a few subcortical and in a juxta-cortical distribution. No areas of abnormal diffusion restriction or abnormal contrast enhancement to suggest active lesions. The brain volume is within the normal range for the patient's age group. Ventricles and basal cisterns are normal. An incidental tiny developmental venous anomaly in the right cerebellar hemisphere.
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The cord demonstrates multiple scattered small segment foci of increased signal on T2 concerning of demyelination, with one central at T5/6 showing contrast enhancement suggesting active lesion. The cord has otherwise normal caliber, with no evident atrophy, and ends at the level of L1. The canal is overall capacious at all levels. There is a mild inversion of the cervical spine lordosis centered at C5/6, with posterior central disc protrusions mildly indenting the cord at C4/5, C5/6, and C6/7. No high-grade foraminal stenosis identified.
Vertebral height and bone marrow signal are unremarkable. The paravertebral soft tissue is unremarkable.
Case Discussion
Imaging features are in keeping with multiple sclerosis. Lesions involve the supratentorial periventricular and juxtacortical white matter, posterior fossa, and spinal cord. One of the spinal cord lesions demonstrates focus of enhancement. Overall lesions satisfy the McDonald criteria for dissemination in time and space.
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