MS VS ADEM

• Maj Satyendra• Ref – BMJ– Radiopaedia– Radiologyassistant.nl

– 31 Aug 13

• Multiple sclerosis relapsing demyelinating disease

• disseminated in space and time

• adolescence and sixth decade, peak at 35 years

• monophasic • acute inflammation and

demyelination • 1-2 weeks after viral

infection or vaccination

• Plaques -ovoid in shape and perivenular in distribution.

• Typical for MS- corpus callosum, U-fibers, temporal lobes, brainstem, cerebellum and spinal cord.

• Coronal PD image of a brain specimen with MS involvement

• involvement of U-fibers in MS.

• RIGHT: U-fibers are not involved

in patient with hypertension.• Juxtacortical lesions are

specific for MS.• adjacent to the cortex

and must touch the cortex.

• Typical findings for MS• Multiple lesions adjacent

to the ventricles (red arrow).

• Ovoid lesions perpendicular to the ventricles (yellow arrow).

• Multiple lesions in brainstem and cerebellum.

• Typical spinal cord lesions in MS are relatively small and peripherally located.

• cervical cord• less than 2 vertebral

segments• A spinal cord lesion with

lesion in the cerebellum or brainstem is very suggestive of MS.

• Dawson fingers• result of inflammation

around penetrating venules.

• Enhancement is another typical finding in MS.

• enhancement present one month after the occurrence of a lesion.

• Simultaneous enhancing and non-enhancing lesions -radiological counterpart of the clinical dissemination in time and space.

• Juxtacortical lesions • located in the U-fibers

are also very specific for MS.

• dissemination in time.

• LEFT: Single lesion on T2WI

• RIGHT: Two new lesions at 3 month follow-up.

ADEM• Diffuse and relatively

asymmetrical lesions• enhance simultaneously

• preferential involvement of the cortical gray matter and the deep gray matter of the basal ganglia and thalami.

• axial FLAIR and T2W-images of a young patient with ADEM

• extensive involvement of the cortical and gray matter, thalamus.

• ADEM can involve the spinal cord, U-fibers and corpus callosum and sometimes show enhancement.

• lesions are often large and in a younger age group

• Grey matterof the basal ganglia often involved

• Lesions are usually bilateral but asymmetrical.

OPEN RING

• sign for demyelination• Ring component :

represent advancing front of demyelination

• open part of the ring usually point towards the grey matter

ADEM

• Complete recovery within one month (50-60%)

• Sequelae (most commonly seizures) (20-30%)