Dawson fingers (multiple sclerosis)


  • A 22 years old lady
  • Sudden onset of left sided weakness for 2 weeks
  • Left sided loss of sensation since 13 days.
  • Clinically had loss of left nasolabial fold
MRI brain T2WI in sagittal plane
MRI brain T2WI in axial planes

MRI findings:

  • There are multiple white matter lesions
  • Juxtacortical lesions involving U-fibres (red arrows)
  • Periventricular lesions (blue arrows)
  • Dawson fingers (yellow arrows)
  • These lesions high signal intensity on T2 and FLAIR sequences, not restricted on DWI and not enhanced post contrast.

Radiological diagnosis: Consistent with multiple sclerosis

Discussion (Dawson fingers):

  • Initially described by James Dawson on histopathological specimens in MS as “wedge-shaped areas with broad base to the ventricle, and extensions into adjoining tissue in the form of finger-like processes or ampullae, in each of which a central vessel could usually be found”.
  • On MRI, Dawson’s fingers are described as elongated, flame-shaped, hyperintense lesions best seen on sagittal FLAIR images (as shown in this case). They are oriented along subependymal veins and thus are perpendicular to the walls of lateral ventricles.
  • This finding is not found in MRI of Neuromyelitis Optica Spectrum Disorders (NMOSD) and can be a differentiating features from MS.
Author: radhianahassan