Answer for BIR CoW 25 March 2018
Multiple sclerosis
Findings
Multiple T2/FLAIR hyperintensities noted in bilateral periventricular & calloso septal interface, perpendicular to lateral ventricles & in right frontal juxta cortical region.Multiple intramedullary central & right posterolateral hyperintensities noted in spinal cord at C2, C3-C4, C6-C7, T2-T3,T3-T4,T6,T7-T8 & T10-T11 levels. Impresion : Multiple demyelinating plaques in bilateral periventricular & calloso septal interface, perpendicular to lateral ventricles & in right frontal juxta cortical region & in multiple cervical & thoracic cord levels – suggestive of Multiple sclerosis.
Discussion
Most MS plaques are hypo- or isointense on T1WI . The hypointensity ("black holes") correlates with axonal destruction. T2WI shows multiple hyperintense linear, round, or ovoid lesions surrounding the medullary veins that radiate centripetally away from the lateral ventricles MS plaques demonstrate transient enhancement during active demyelination. Punctate, nodular, linear, and rim patterns are seen. A prominent incomplete rim ("horseshoe") of enhancement with the "open" nonenhancing segment facing the cortex can be present. McDonald criteria : Dissemination in Space ≥ 1 T2 hyperintense lesion(s) In at least 2 of the following 4 areas Periventricular Juxtacortical Infratentorial Spinal cord Dissemination in Time Either new T2 or Gd-enhancing lesion(s) on follow-up MR Or simultaneous presence of Asymptomatic Gd-enhancing and Nonenhancing lesions at any time
Findings
Multiple T2/FLAIR hyperintensities noted in bilateral periventricular & calloso septal interface, perpendicular to lateral ventricles & in right frontal juxta cortical region.Multiple intramedullary central & right posterolateral hyperintensities noted in spinal cord at C2, C3-C4, C6-C7, T2-T3,T3-T4,T6,T7-T8 & T10-T11 levels. Impresion : Multiple demyelinating plaques in bilateral periventricular & calloso septal interface, perpendicular to lateral ventricles & in right frontal juxta cortical region & in multiple cervical & thoracic cord levels – suggestive of Multiple sclerosis.
Discussion
Most MS plaques are hypo- or isointense on T1WI . The hypointensity ("black holes") correlates with axonal destruction. T2WI shows multiple hyperintense linear, round, or ovoid lesions surrounding the medullary veins that radiate centripetally away from the lateral ventricles MS plaques demonstrate transient enhancement during active demyelination. Punctate, nodular, linear, and rim patterns are seen. A prominent incomplete rim ("horseshoe") of enhancement with the "open" nonenhancing segment facing the cortex can be present. McDonald criteria : Dissemination in Space ≥ 1 T2 hyperintense lesion(s) In at least 2 of the following 4 areas Periventricular Juxtacortical Infratentorial Spinal cord Dissemination in Time Either new T2 or Gd-enhancing lesion(s) on follow-up MR Or simultaneous presence of Asymptomatic Gd-enhancing and Nonenhancing lesions at any time
Note:
We do not discourage differential diagnosis. But all the differentials must satisfy the findings noted in the case.
If you feel you have answered rightly but cannot find your name in the above list, please call 09551942599.
Did you Know?
The order in which the names appear in this winner's list is based on the time of submission. The first person to send the correct answer gets his/her name on top of the list!
We do not discourage differential diagnosis. But all the differentials must satisfy the findings noted in the case.
If you feel you have answered rightly but cannot find your name in the above list, please call 09551942599.
Did you Know?
The order in which the names appear in this winner's list is based on the time of submission. The first person to send the correct answer gets his/her name on top of the list!