Multiple sclerosis, case 3

Clinical history
This 42-year-old female was referred for MRI with the diagnosis of an acute T8-T9 cord compression. MRI demonstrated an intramedullary lesion at the T3-T4 level.

First MRI
Image 1: Sagittal T1WI and Gd T1WI. The spinal cord appears normal on non-enhanced T1-weighted images. After Gadolinium injection an oval-shaped, well-defined lesion enhances homogeneously at the T3-T4 level.
Image 2: Axial Gd T1WI. This confirms the intramedullary location of the lesion, limited to the right side of the cord.
Images 3 - 4: Sagittal T2WI and PD image. These images show only mild spinal cord enlargement, with an ill-defined hyperintense appearance of the upper thoracic cord.

Suggested differential diagnosis included astrocytoma, an inflammatory lesion, and MS.
Surgical exploration was elected due to the significant clinical evolution in this young patient.

Surgery
No definite tumor infiltration could be found and only biopsy was performed. No final histological diagnosis could be provided at the time of surgery.

Follow-up MRI
Images 5 - 6: Sagittal Gd T1WI. Persistent enhancing thoracic lesion.
Images 7 - 8: Sagittal PD image and T2WI. On these sequences the lesion is equally well seen as a high signal intensity, ill-defined lesion.
Image 9: Axial PD/T2WI. Brain MRIs show multiple white matter lesions consistent with MS.
This final diagnosis was confirmed by CSF examination.

Search also:
- Multiple sclerosis

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