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Multiple sclerosis, case 2

 

Clinical history
This 28-year-old female noticed the sudden onset of paresthesia and hypoesthesia of the left arm, and hypoesthesia of the left hemithorax. Impairment of sensation in the legs was also present.

First MRI (April 1991)
Image 1: Sagittal T1WI. Discrete enlargement of the upper cervical cord.
Image 2: Sagittal T2WI. Although flow artifacts degrade this T2-weighted image, a high signal intensity lesion is clearly identified in the posterior half of the spinal cord at the C2 level.
Image 3: Sagittal Gd T1WI. After contrast injection, the lesion shows ring enhancement, confirmed on the axial images.
Image 4: Axial Gd T1WI. Confirms the posterior location of this lesion, slightly offset to the left side.

Comment
Only a solitary lesion was clearly visible in the spinal cord. While MR of the brain was normal, MS remained the first clinical diagnosis. CSF examination was normal as well.

Follow-up MRI (August 1992)
Images 5 - 6: Sagittal T1WI. Normal appearance of the spinal cord.
Image 7: Sagittal PD image and image 9: T2WI. A new cord lesion is seen at the midthoracic level (see image 8 and image 10).
Image 11: Sagittal T2WI at the cervical level shows the C2 lesion as a vague hyperintense area.
Images 12 - 13: Sagittal Gd T1WI. After Gadolinium injection, no definite contrast uptake was seen in these two lesions.

Follow-up MRI (February 1995)
Image 14: Sagittal T2WI.
Image 15: Sagittal PD image.
Image 16: Sagittal Gd T1WI.
Images 17 - 20: Axial T2WI.
The thoracic lesion is no longer visible, while the upper cervical lesion remains clearly identified, especially on the axial T2-weighted images.

Comment
During this five year period, the clinical symptomatology fluctuated and was mainly characterized by sensory disorders. The last CSF examination confirmed the final diagnosis of MS.

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- Multiple sclerosis

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Fig. 1

Multiple sclerosis, case 2, Fig. 1
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Multiple sclerosis, case 2, Fig. 14
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Multiple sclerosis, case 2, Fig. 17
Multiple sclerosis, case 2, Fig. 18
Multiple sclerosis, case 2, Fig. 19
Multiple sclerosis, case 2, Fig. 20