Acute onset of right lower limb hemiparesis and right upper limb hemiparesthesia. Known from the clinics due to long-term treatment.
MRI Cervical Spine and Brain (selected images)
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There are multiple foci of an increased T2/STIR signal along the cord, in particular, a long segment one from C5 to C7, which has a central medullary distribution and a central bright spot. These lesions do not demonstrate enhancement (post-contrast sequences not shown). The selected images of the brain (FLAIR) show multiple scattered subcortical and deep white matter foci of increased signal, which predominantly involve the frontal lobes.
Note that, differently from multiple sclerosis, the cord involvement occurs with long segments (about three spinal levels) and a central modular distribution. Also, this case demonstrates central bright spotty, which has been inferred to be a discriminative finding of NMO over MS 1.
Regarding the brain findings, this patient has deep and subcortical punctate white matter lesions, which do not exhibit the classic distribution usually seen on MS.