Multiple Sclerosis

Case Contribution: Assoc. Prof. Dr Hilwati Hashim


  • A 21 years old female
  • Presented with 2 weeks history of right upper limb numbness and blurring of vision.
  • She has had a similar episode 6 months previously which lasted for about 1 week and resolved spontaneously with no residual symptoms.
MRI of brain and spine; (a) Axial T1WI, (b) Axial FLAIR, (c) Axial T2WI, (d) Sagittal FLAIR and (e) Sagittal T2

MRI findings:

  • Bilateral T2/FLAIR hyperintense lesions at periventricular region which are perpendicular to the lateral ventricle (yellow arrows)
  • Juxtacortical white matter at left frontal lobe (red arrow)
  • A hypointense lesion on T1W at the left posterior parietal lobe “black-hole” (white arrow)
  • A short segment lesion at T6 level of the spinal cord (blue arrow)
  • No enhancing lesion is seen (images not shown)

Diagnosis: Multiple sclerosis.


  • Distribution of the intracranial and spinal lesion fulfills the 2017 McDonald’s criteria for Multiple Sclerosis for Dissemination in Space.
  • No enhancing lesion seen post contrast suggest that there is no active disease at the time of scan.
  • Criteria for Dissemination in Time is not fulfilled in this case. If there is a baseline scan  available (for example: done at the time of the previous attack), comparison can be made to look for new T2 hyperintense lesion, another criteria for Dissemination in Time.
  • Lesions which are hypointense on T1WI reflects more tissue damage in term of demyelination as well as axonal loss.
  • CSF analysis which demonstrates elevated IgG or oligoclonal bands is useful to support the clinical diagnosis, particularly when the clinical attacks are doubtful or MRI criteria is not fulfilled.
Author: radhianahassan