Short case...Spinal multiple sclerosis

1. Short case publication... version 2.5 | Edited by professor Yasser Metwally | November 2008
Short case
Edited by
Professor Yasser Metwally
Professor of neurology
Ain Shams university school of medicine
Cairo, Egypt
Visit my web site at:
http://yassermetwally.com
A 30 years old female patient known to be suffering from relapsing, remitting multiple sclerosis presented clinically with
paraplegia with a sensory level.
DIAGNOSIS: SPINAL MULTIPLE SCLEROSIS

2. Figure 1. Precontrast MR T1 images showing a huge right sided intraventricular /parenchymal cyst associated with
agenesis of the septum pellucidum. The corpus callosum is markedly hypoplastic and deficient. The cerebral cortex
is lissencephalic. Notice the right sided hemimegalencephaly and the subependymal nodular heterotopia. Subcortical
band heterotopia can also be appreciated.
Figure 2. A case of spinal multiple sclerosis. MRI T2 images showing pencil shaped multiple sclerosis plaques
that occupy 2-3 spinal segments The plaques are orientated along the longitudinal axis of the spinal cord on
sagittal sections. The plaques are short (less than two spinal segments), pencil shaped, multiple and well
demarcated. No evidence of spinal cord atrophy. The spinal cord parenchyma is asymmetrically involved.
Diffuse abnormalities seen as poorly demarcated areas of increased signal intensity on MRI T2 images are also
seen in this study. Diffuse abnormalities are more common in primary progressive MS and secondary
progressive MS.

3. Figure 3. A case of spinal multiple sclerosis. MRI T2 images showing pencil shaped multiple sclerosis plaques
that occupy 2-3 spinal segments The plaques are orientated along the longitudinal axis of the spinal cord on
sagittal sections. The plaques are short (less than two spinal segments), pencil shaped, multiple and well
demarcated. No evidence of spinal cord atrophy. The spinal cord parenchyma is asymmetrically involved.
Diffuse abnormalities seen as poorly demarcated areas of increased signal intensity on MRI T2 images are also
seen in this study. Diffuse abnormalities are more common in primary progressive MS and secondary
progressive MS.
Figure 4. MRI T2 images in a patient with spinal multiple sclerosis showing a peripherally located hyperintense
MS plaque. The plaque is surrounded by a hypointense incomplete ring that could be due to the presence of
paramagnetic free radicals within the phagocytosing macrophages which are heterogeneously distributed in the
periphery of the inflammatory lesion, paramagnetic free radicals induce T2 hypointensity. Spinal cord
demyelinating plaques present as well circumscribed foci of increased T2 signal that asymmetrically involve the
spinal cord parenchyma. They are characteristically peripherally located, are less than two vertebral segments in
length, and occupy less than half the cross-sectional area of the cord. On axial MR images, the lesions located in the
lateral segments have a wedge shape with the basis at the cord surface or a round shape if there is no contact with
the cord surface. The distribution of MS lesions in the spinal cord closely corresponds to venous drainage areas.

4. Addendum
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References
1. Metwally, MYM: Textbook of neurimaging, A CD-ROM publication, (Metwally, MYM editor) WEB-CD agency for
electronic publishing, version 9.4a October 2008