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Multiple sclerosis, case 4

 

Clinical history
The clinical history of this 44-year-old female began six years before with a first episode of paresthesias of the left hand and fingers. No definite diagnosis was made at that time. She remained symptom-free for a period of five years. Then the patient presented with neuralgia at the T8-T10 level, diagnosed as herpes zoster. It was only in 1994 that MS was clinically suspected, when the patient presented with an episode of paresthesia of the right leg and impairment of pain and temperature sensation. At that time an MRI was performed.

MRI
Image 1: Sagittal T1WI. No definite abnormalities are seen on these T1-weighted images.
Image 2: Sagittal T2WI. There is a questionable high-signal intensity lesion in the conus, and a definite hyperintense area in the thoracic cord, seen at the top border of the image, confirmed on the next image.
Image 3: Sagittal T2WI centered on the upper thoracic and cervical spinal cord. A pencil-shaped hyperintense lesion is seen, anteriorly located at the T7-T8 level.
Image 4: Sagittal Gd T1WI shows contrast enhancement of the thoracic lesion.
Images 5 - 6: Axial T2WI and Gd T1WI confirm the thoracic lesion, restricted to the left side.
Image 7: Axial T2WI of the brain shows left temporal and right subcortical frontal lesions, consistent with MS.
Images 8 - 10: Axial Gd T1WI and image 11: Sagittal Gd T1WI of the brain show enhancement of all cerebral lesions as well.

Follow-up clinical course
The patient was treated with high-dose corticosteroids and most of the symptoms resolved.

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Fig. 1

Multiple sclerosis, case 4, Fig. 1
Multiple sclerosis, case 4, Fig. 2
Multiple sclerosis, case 4, Fig. 3
Multiple sclerosis, case 4, Fig. 4
Multiple sclerosis, case 4, Fig. 5
Multiple sclerosis, case 4, Fig. 6
Multiple sclerosis, case 4, Fig. 7
Multiple sclerosis, case 4, Fig. 8
Multiple sclerosis, case 4, Fig. 9
Multiple sclerosis, case 4, Fig. 10
Multiple sclerosis, case 4, Fig. 11