PMC8297737_01
Initial MRI of the brain demonstrating rather typical finding of demyelinating disease fulfilling McDonald diagnostic criteria for multiple sclerosis. (a) Short-tau inversion recovery (STIR) image of the cervical and upper thoracic spine in sagittal plane revealing several hyperintense lesions (level C1/2, Th3/4, and Th6). (b,d) 3D fluid-attenuated inversion recovery (FLAIR) images of the brain in the sagittal plane. (e) T2-weighted image in the coronal plane. (c) Contrast-enhanced T1-weighted image with magnetization transfer in sagittal plane. Brain MRI revealed several periventricular white matter lesions including the largest FLAIR hyperintense plaque within the corpus callosum (b,e) with punctate enhancement (c). Image (d) shows some of the other smaller lesions near the trigone of the left lateral ventricle.
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F1
A 23-year-old female was admitted to the neurological department of a major university hospital presenting with a mild central paraparesis of the lower extremities; an MRI indicated T2-hyperintense lesions in a periventricular, infratentorial, and intramedullary localization; both contrast-enhancing and non-enhancing lesions were found (Figure 1).
MRI of the brain and cervical spine documenting a significant progression of the tumefactive lesions. (a-c) Examination performed ~5 years after the initial diagnosis of multiple sclerosis, (d-f) follow-up examination after further 22 months. Several tumor-like enhancing lesions located around the lateral ventricles are visible on axial T2-weighted images (b,d) and contrast-enhanced axial T1-weighted images (c,f). Extensive mass lesion located within the septum pellucidum finally caused the hydrocephalus by obstruction of the interventricular foramina; a significant dilatation of the lateral ventricles is seen on follow-up examination (d,f). The progressive course of the disease is also demonstrated by T2-weighted images of the cervical spine in the sagittal plane (a,e).
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F2
An MRI of the brain and spinal cord showed multiple TDLs (Figure 2). At the age of 29, cognitive and gait problems together with a headache and papilledema occurred, and a diagnosis of obstructive hydrocephalus (Figure 2) was established.
Histopathological findings (tumefactive lesion in the left occipital lobe). Hematoxylin-eosin. Red arrow: plaque with loosing of neuropil and reactive gliosis. Blue arrow: normal myelinated CNS tissue (50x magnification). CNS, central nervous system.
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F3
Histopathological findings revealed demyelination (Figures 3, 4).
Histopathological findings (tumefactive lesion in the left occipital lobe). Luxol fast blue/periodic acid-Schiff (PAS) staining. Red arrows: area of demyelination in plaque (pinkish color of PAS). Blue arrows: areas of normal myelination (bluish staining of myelin by luxol fast blue) (100x magnification/50x magnification).
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F4
Histopathological findings revealed demyelination (Figures 3, 4).