PMC8486554_01
MRI brain and spine of son: (a) T2 sagittal, (b) T2 FLAIR axial, (c) T1 axial images demonstrate numerous T2 high signal T1 low signal white matter lesions arranged perpendicular to the bilateral lateral ventricles suggesting Dawson's fingers. Lesions involve the corpus callosum, callasoseptal interface, and posterior fossa. T2 axial image of the orbits (d) shows right optic neuritis. Cervical spine T2 sagittal (e) and axial (f) images demonstrate multiple short segment T2 high signal lesions without significant spinal cord edema and expansion. Lesions are not contrast enhancing.
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MRI brain (Figure 1) showed multiple discrete T2-weighted and flair hyperintensities in periventricular, juxtacortical, and infratentorial regions with and without gadolinium enhancement.
Optical coherence tomography shows retinal nerve fiber layer of optic nerve heads. (a) Mother: bilateral severely affected retinal nerve fiber layer. (b) Son: severely affected superior, inferior, and temporal quadrants of the left eye and severely affected temporal quadrant of the right eye.
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His OCT (Figure 2) showed bilateral temporal visual field retinal nerve fiber layer (RNFL) thinning. VEP was absent in her left side, and OCT showed bilateral RNFL thinning (Figure 2).
T2 FLAIR axial (a, b) and T2 axial (c) show multiple periventricular Dawson's fingers and juxtacortical lesions. Significant cerebral atrophy is seen with enlarged lateral ventricles suggesting chronic disease. T2 sagittal images of the cervical and upper dorsal spine (d) show multiple short segment lesions without significant cord expansion.
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Neuroimaging (Figure 3) was suggestive of MS, and CSF-OCB was positive.