Presentation
Left sided numbness and altered sensation/tingling.
Patient Data
Multiple lesions throughout the brain with high T2 signal. Different grades of enhancement, and two active lesions with avid contrast in the right periventricular white matter consistent with the left-sided sensory changes.
There are lesions in the periventricular, juxtacortical, brainstem and cerebellar spaces as well as the cervical cord.
SUMMARY
Active multiple sclerosis.
Case Discussion
These findings are typical for multiple sclerosis.
These "plaques" are evidence of damage to the protective sheath around the axons - demyelination. They are usually bright/high signal on T2 and especially evident on FLAIR sequences. Also, active areas of demyelination enhance with contrast - as the right periventricular lesions do in this case (consistent with his presentation of left sided sensory changes).
MRI is the best investigation to chartacterise these lesions. As said, CT does not give enough information and also as the majority of MS patients are young to middle-aged adults, recurrent CTs carry risks.
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Thanks to Dr Frank Gaillard for originally contributing the case and the discussion. The original is available here.
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