Multiple sclerosis


  • A 20 years old lady
  • Diagnosed multiple sclerosis 6 years ago
  • Initial presentation: bilateral spastic paraparesis
  • Also had bilateral cerebellar sign and unsteady gait.
MRI brain axial plane T2-weighted images
MRI brain axial plane T2FLAIR sequence
MRI brain axial plane T1+Gadolinium sequence

MRI findings:

  • There are multiple T2-hyperintense lesions in the cerebellum, midbrain, and periventricular region (yellow arrows): dissemination in space
  • The lesions at periventricular region are perpendicularly orientated to the ventricle
  • Some of the lesions show enhancement post contrast (red arrows) while others show no enhancement: dissemination in time
MRI brain axial plane T2FLAIR sequences
  • new lesions are seen during subsequent imaging

Diagnosis: Multiple sclerosis


  • Multiple sclerosis is an acquired chronic relapsing demyelinating disease involving the central nervous system
  • The presentation is usually between adolescence and the sixth decade, with a peak at approximately 35 years of age
  • Revision of McDonald diagnostic criteria as follows:
2005 2010 2017
Gado-enhancing lesion or 9 T2-lesions Periventricular Periventricular
At least 3 periventricular T2-lesions Juxtacortical Juxtacortical/Cortical
At least 1 infratentorial or spinal cord T2-lesion Infratentorial Infratentorial
At least 1 juxtacortical T2-lesion Spinal cord (excluded if symptomatic lesions) Spinal cord
(at least 3 of above required) 1≥ T2 lesion at least 2 of 4 areas 1≥ T2 lesion at least 2 of 4 areas

No distinction of symptomatic or non-symptomatic lesion

Author: radhianahassan