Upcoming Events
Log In
Pricing
Free Trial

Case: New Neurologic Deficit from Multiple Sclerosis

HIDE
PrevNext

0:01

This was a 35-year-old who presented with right

0:04

hemiparesis, and the concern was for a stroke.

0:07

What we saw on the FLAIR scan and the T1

0:11

post-gadolinium scan was a white matter region that

0:16

did not extend all the way to the gray matter.

0:19

It was not wedge-shaped, and it had an

0:21

unusual open ring enhancement pattern.

0:25

This open ring enhancement

0:26

pattern is pretty characteristic

0:29

of tumefactive multiple sclerosis,

0:32

and that's what this patient had.

0:34

So remember that in young patients, new

0:37

neurologic deficits may be a manifestation of

0:41

demyelinating disorders, and I refer you to my

0:44

previous mastery course on white matter disease.

0:49

Here is another patient who had what was

0:52

thought to be a TIA, a new neurologic deficit.

0:55

Same age, 35 years of age, and look at this patient.

0:59

New diagnosis: multiple white matter regions that

1:03

are in the periventricular, as well as in the

1:06

subcortical regions, as well as in the posterior

1:09

fossa, some of which showed gadolinium enhancement,

1:14

and some of which did not show contrast enhancement.

1:19

We have now defined the McDonald

1:21

criteria for multiple sclerosis.

1:24

Lesions that are disseminated in space.

1:27

We have three out of four locations:

1:30

periventricular, subcortical, and posterior fossa,

1:33

the fourth being the spine.

1:35

And we have dissemination in time by virtue of the

1:39

fact that we have some of the demyelinating lesions

1:43

that are enhancing and some up here in the frontal

1:46

region, which are not showing contrast enhancement.

1:49

So, fulfillment of McDonald

1:51

criteria for multiple sclerosis.

Report

Faculty

David M Yousem, MD, MBA

Professor of Radiology, Vice Chairman and Associate Dean

Johns Hopkins University

Tags

Vascular

Neuroradiology

MRI

Emergency

Brain

© 2025 Medality. All Rights Reserved.

Contact UsTerms of UsePrivacy Policy