43 y/o woman was admitted whit sudden unset of nausea and Fatigue. She has history of Numbness in Lt upper limbs

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Doctor's Information

Name : Hamidreza
Family : Haghighatkhah
Affiliation :Radiology department,ShohadaTajrish Hospital,SBMU
Academic Degree : Associate professor of Radiology
Email : This email address is being protected from spambots. You need JavaScript enabled to view it.
Resident : Hadi Zolfeghari

Case Section

Neuroradiology

Patient's Information

Gender : Female
Age : 43

Clinical Summary

43 y/o woman was admitted whit sudden unset of nausea and Fatigue. She has history of Numbness in Lt upper limbs

Imaging Findings

Widespread periventricular , subcortical & white matter regions of hyperintensity on T2 are present including some which demonstrate enhancement. Single T2 weighted axial image through the cervical cord demonstrates a well defined high signal region affecting the Lt dorsal column According to Polman criteria DIS & DIT are present.

Differential Diagnosis

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Final Diagnosis

multiple sclerosis

Discussion (Related Text)

An unpredictable disease of the central nervous system, multiple sclerosis (MS) can range from relatively benign to somewhat disabling to devastating, as communication between the brain and other parts of the body is disrupted. Many investigators believe MS to be an autoimmune disease - one in which the body, through its immune system, launches a defensive attack against its own tissues. multiple sclerosis requires establishing disease disseminated in both space and time.
Dissemination in space
Dissemination in space requires ≥1 T2 bright lesions in two or more of the following locations 1:
• periventricular
• juxtacortical
• infratentorial
• spinal cord
o if a patient has a brainstem/spinal cord syndrome, the symptomatic lesion(s) are excluded from the criteria, not contributing to the lesion count
Dissemination in time
Dissemination in time can be established in one of two ways:
1. a new lesion when compared to a previous scan (irrespective of timing)
o T2 bright lesion and/or gadolinium enhancing
2. presence of asymptomatic enhancing lesion and a non-enhancing T2 bright lesion on any one scan.

References

1- National Center for Biotechnology Information, U.S. National Library of Medicine 8600 Rockville Pike, Bethesda MD, 20894 USA
2- AskMayoExpert. What is multiple sclerosis? Rochester, Minn.: Mayo Foundation for Medical Education and Research; 2014.
3- Sheldon JJ, Siddharthan R, Tobias J et-al. MR imaging of multiple sclerosis: comparison with clinical and CT examinations in 74 patients. AJR Am J Roentgenol. 1985;145 (5): 957-64. AJR Am J Roentgenol (abstract) - Pubmed citation
4- Richards TL. Proton MR spectroscopy in multiple sclerosis: value in establishing diagnosis, monitoring progression, and evaluating therapy. AJR Am J Roentgenol. 1991;157 (5): 1073-8. AJR Am J Roentgenol (abstract) - Pubmed citation