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Joseph Junewick, MD FACR
over 9 years ago
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ARSt Case Repository

Multiple Sclerosis

Case Detail

Anatomy: Brain-Spine
Joseph Junewick, MD FACR
Diagnostic Category: Infectious-Inflammatory
Created: over 9 years ago
Updated: over 9 years ago
Tags: PEDS
Modality/Study Types: MR
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Teenager with double vision and frequent falls.

Case Images


Multiple Sclerosis

Clinical Notes

Similar episode of diplopia 1-1/2 years ago. Previous episode of generalized numbness. The patient denies vision loss or eye pain.

His mother has similar white matter lesions on MRIs.


MR – T2 intense foci involving the perilateral ventricular and subcortical white matter, and also the thalami, cerebral peduncles, midbrain and brainstem.


The diagnosis of MS is based on clinical and imaging findings. Symptoms include visual impairment, paresthesias, gait disturbances, motor anomalies, and cranial nerve palsies. MR findings in the brain include T2-intense foci in the periventricular and other white matter lesions, with enhancement indicating active demyelination. Concommitant lesions in the spinal cord greatly increase specificity for MS. In the pediatric population, patients are more likely to have seizures, brainstem, and cerebellar symptoms than adult patients, although their scans may show relatively fewer lesions given the severity of their symptoms. Efficacy of therapy has not been established, and the disease can lead to significant morbidity during important developmental years.


Bot JCJ, et al. Differentiation of Multiple Sclerosis from Other Inflammatory Disorders and Cerebrovascular Disease: Value of Spinal MR Imaging. Radiol. Apr 2002, 223, 46-56.

Smirniotopoulos, JG. Patterns of Contrast Enhancement in the Brain and Meninges. RadioGraphics Mar 2007, 27, 525-551.


Matt Ripplinger, MD

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