Multiple sclerosis - brain and spine

Case contributed by Dr Abiola Ayodele

Presentation

History of bilateral visual loss 3 years ago, she regained her sight after treatment with steroids. Progressive lower limb weakness of 3 years duration.

Patient Data

Age: 40 years
Gender: Female

MRI shows T2/FLAIR ovoid hyperintensities distributed along the medullary veins, perpendicular to the body of the lateral ventricles and callososeptal interface- the so-called Dawson fingers. They display low signals on T1 weighted images; black holes. No appreciable enhancement is seen post gadolinium administration. Similar lesions are noted in the brainstem.

Multiple demyelinating plaques in the spinal cord are most prominent on T2 and STIR sequences.

Case Discussion

Multiple sclerosis is a relatively common acquired chronic relapsing demyelinating disease involving the central nervous system, and is the second most common cause of neurological impairment in young adults, after trauma. Characteristically, and by definition, there is dissemination in space (i.e. multiple lesions in different regions of the brain; periventricular, juxtacortical, brainstem, and spinal cord ) and also in time (i.e. lesions occur at different times). The presentation is usually between adolescence and the sixth decade, with a peak at approximately 35 years of age. There is a strong female predilection with a F: M ratio of approximately 2:1. 

The above MRI findings demonstrate the characteristic black holes on T1 and Dawson fingers on T2/FLAIR sequences. The patient subsequently had CSF analysis which showed oligoclonal bands.

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