Presentation
Complained of neck pain and pins and needles in arm and hand. Referred for MRI head and spine.
Patient Data
Note: This case has been tagged as "legacy" as it no longer meets image preparation and/or other case publication guidelines.
The cervical study shows disc/ostephyte complex at C5/6 on the left with lateral recess stenosis and foraminal narrowing. Focal increased signal within the cord on T2 axial.
The cranial study shows an ovoid lesion in left centrum semiovale which is hyperintense on FLAIR and T2 and hypointense on T1. It shows increased diffusion on DWI/ADC. The sagittal sequence shows the lesion to extend to the lateral ventricle. On SWI there is a central vein sign and an 'iron rim' of hemosiderin. Multiple additional small white matter intensities on axial FLAIR are noted.
Case Discussion
The central vein sign and the iron rim sign may (in conjunction with appropriate clinical findings) support a diagnosis of primary demyelination. The central vein reflects the perivenular nature of demyelination in multiple sclerosis. The iron rim reflects hemosiderin in macrophages in the subacute phase of lesion evolution, this later disappears as the macrophages disperse.
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