Multiple Sclerosis, spinal cord with active lesion

Findings:

A patchy lesion with abnormal enhancement compatible with active demyelination involves the right lateral aspect of the spinal cord at C5-6. Nonenhancing lesions involve the left lateral margin of the spinal cord at C3 and left dorsal aspect at C4-5. A lesion also involves the right ventral aspect of the cord at C4-5 (not all are shown).

Discussion/Differential Diagnosis:

It is quite common to see nonenhancing spinal cord lesions in patients with multiple sclerosis, but it is distinctly uncommon to confirm enhancing cord lesions which signify active demyelination on follow up studies after the initial diagnosis. The presence of an enhancing or nonenhancing cord lesion without cord expansion should lead to evaluation of the brain for demyelination. If disease is isolated to the cord, transverse myelitis or neuromyelitis optica should be considered. If an enhancing cord lesion is expansile and nodular, spinal cord neoplasm should be suspected.

Case prepared in part by Josh Hall, UC Undergraduate

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