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Findings

Multiple lesions

White matter distribution

Periventricular

Corona radiata

Subcortical

Hyperintense on Flair

Iso to low signal on T1

Nodular enhancement of some of the lesions

No significant mass effect / surrounding edema

Differential Diagnosis

Multiple sclerosis

ADEM

Autoimmune vasculitis

Lyme disease

Small vessel ischemic disease (no enhancement)

Metastatic disease (edema)

Multiple Sclerosis

Imaging Findings

Multiple perpendicular callososeptal T2 hyperintensities

Bilateral, asymmetric linear/ovoid FLAIR hyperintensities

Perivenular extension – “Dawson finger”

Lesions enhance during the active demyelination phase

Rarely present as large peripherally enhancing mass like lesion

95% of clinically definite MS patients have positive MR findings.

3.0T Vs 1.5T

21% increase in number of contrast enhancing lesions

30% increase in enhancing lesion volume

10% increase in total lesion volume

Presentation

Impaired / double vision of acute optic neuritis (50% with positive MR will develop MS)

Weakness, numbness, tingling, gait disturbances

Cranial nerves palsy

Spinal chord symptoms in 80%

CSF positive for oligoclonal bands

Age: 20-40, peak age = 30

M:F = 1:1.7-2

Caucasians most commonly affected. Occurs most commonly in temperate zones

45% of patients not severely affected

> 80% of patients with probably MS and positive MR findings will progress to clinically definite MS

Majority of patients have a protracted course with progression of deficits

Severe disability and cognitive impairment is seen late in the course of disease.

Treatment is with immunomodulators or immunosuppressant drugs.

Katzman GL: Multiple Sclerosis. In Osborne AG: Diagnostic Imaging: Brain. Salt Lake City, 2004, Amirsys.