Wallerian degeneration in multiple sclerosis
A known case of neglected multiple sclerosis with deteriorating motor symptoms.
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MRI of the brain demonstrates typical appearance of Multiple sclerosis including Dawson fingers and multiple abnormal foci of altered signal involving the corpus callosum. Abnormally small size of the left cerebral peduncle with no signal changes. Preserved volume of the right cerebral peduncle with abnormal high T2 signal changes.
A case with multiple sclerosis complicated with Wallerian degeneration of both cerebral peduncles (stage 4 on the left and stage 3 on the right). White matter demyelination alone may not be the only cause of progressive disability tin patient with MS, Wallerain degeneration of the ipsilateral corticospinal tract may be a major contributor in this disability as illustrated in our case.