Multiple Sclerosis

Dawson's fingers: numerous ovoid, flame-shaped periventricular foci of T2 prolongation, many of which are oriented perpendicular to the lateral ventricles and some of which extend into the subcortical U fibers.

Multiple Sclerosis: A varied disorder with an equally varied clinical presentation reflecting the complex autoimmune inflammatory demyelination of the central nervous system as the core pathology. The cause of multiple sclerosis is still unknown. The disease course is characterized by flares and relapses.

Epidemiology: The disease impacts females more than males and the average age of onset is thirty years old. White populations appear to be at a higher risk than others.

Risk Factors: While exact risk factors are unknown, those with other autoimmune disorders are at a greater risk of suffering from multiple sclerosis. Although often falsely speculated in the public, no link between vaccines and multiple sclerosis has ever been demonstrated. Interestingly, there is a noted association between frequency of multiple sclerosis and extreme latitudes perhaps reflecting the protective nature of sunlight.

Signs: Multiple sclerosis may be difficult to diagnose as there are not any unique clinical manifestations but rather a myriad of variable presentations. Chief among these include optic neuritis resulting in unilateral acute eye pain that is accentuated with eye movement. Patients may also experience sensory symptoms including altered proprioception, light touch, pain, and vibration sensation. However, many patients will also experience severe pain with disease flares. At times patients may also present with motor symptoms including paraparesis or paraplegia and coordination difficulties. Bladder, bowel, and sexual dysfunction are also common.

Differential Diagnosis: CNS neoplasms or infections such a Lupus, Stroke, Other autoimmune disease.

Diagnosis: Various criteria, including the McDonald criteria, have been created to help in the diagnosis of multiple sclerosis. However, MRI remains of gold standard for diagnosis.

Disease Course: Multiple sclerosis is characterized by flares and relapses of variable duration. The disease can follow several patterns including relapsing remitting, secondary progressive, primary progressive, or progressive relapsing.

Treatment: Immunosuppression remains the mainstay of therapy. During acute exacerbations, high dose glucocorticoids are used and if unsuccessful then plasma exchange may be employed as well.

 


Case #1a. Coronal post-contrast: abnormal enlargement and enhancement of left optic nerve.





Case #1b. Dawson's fingers on sagittal FLAIR.