While lesions can occur in any CNS region, relative to other disorders that cause white matter lesions, multiple sclerosis lesions tend to affect specific white matter regions, such as the periventricular and juxtacortical white matter, the corpus callosum, infratentorial areas (especially the pons and the cerebellum) ...
Lesions may be observed anywhere in the CNS white matter, including the supratentorium, infratentorium, and spinal cord; however, more typical locations for MS lesions include the periventricular white matter, brainstem, cerebellum, and spinal cord.
An “average” number of lesions on the initial brain MRI is between 10 and 15. However, even a few lesions are considered significant because even this small number of spots allows us to predict a diagnosis of MS and start treatment.
Spinal cord lesions are more commonly seen in progressive forms of multiple sclerosis, and they can result in an increased risk of disability.
Classically, the MRI shows lesions in the white matter deep in the brain near the fluid spaces of the brain (the ventricles). The test may also show changes in the cortex or near the cortex. MRI can also show changes in the brainstem and in the spinal cord.
In general, MS lesions are hyperintense or bright on T2 or FLAIR sequences. Hypointense lesions are dark or black. In general, old MS lesions are hypointense or dark on T1 sequences (“black holes”). Isointense lesions are gray, the color of surrounding brain tissue.
Most symptoms develop abruptly, within hours or days. These attacks or relapses of MS typically reach their peak within a few days at most and then resolve slowly over the next several days or weeks so that a typical relapse will be symptomatic for about eight weeks from onset to recovery. Resolution is often complete.
Many with spinal cord problems and MS have numbness on one side of the body and weakness on the opposite side. They may lose standing balance or have a gait problem characterized by ataxia, such as the inability to walk a straight line. Paralysis and loss of sensation of part of the body are common.
Spinal cord lesions are common in MS. They're found in about 80 percent of people newly diagnosed with MS. Sometimes the number of spinal lesions identified from an MRI can provide the doctor with an idea of the severity of the MS and the likelihood of a more serious episode of demyelination occurring in the future.
For the diagnosis of multiple sclerosis, there should be at least one typical multiple sclerosis lesion in at least two characteristic regions [periventricular (abutting the lateral ventricles), juxtacortical/cortical, infratentorial, spinal cord] to support dissemination in space (Thompson et al., 2018).
What do MS lesions feel like? Even though the central nervous system is packed with nerve cells, the brain tissue itself does not have so-called noniceptors — the sensory nerve fibers that detect pain and potentially damaging stimuli. Thus, MS lesions themselves cannot be felt.
MS activity appears on an MRI scan as either bright or dark spots. Typical MS lesions tend to be oval or frame shaped. MS lesions can appear in both the brain's white and gray matter. Healthcare professionals may use a chemical contrast dye called gadolinium to improve the brightness of MRI scan images.
Numbness or Tingling
Numbness of the face, body, or extremities (arms and legs) is often the first symptom experienced by those eventually diagnosed as having MS.
Diagnosing MS
More than 90% of people with MS have scar tissue that shows up on an MRI scan. A spinal tap can check for abnormalities in the fluid that bathes the brain and spinal cord. Tests to look at electrical activity of nerves can also help with diagnosis.
MS brain lesions can cause coordination problems, dizziness, slurred speech, muscular weakness, and sensation loss. The location of these lesions dictates which symptoms a person experiences. There is no cure for MS, but several treatment modes can help people to manage the condition.
The course of enhancement is transient and usually is shorter than 6 months; rarely it may persist for a longer time. The appreciation of the evolution of MS-enhanced lesions aids in both identifying new MS lesions and distinguishing these lesions from other pathologic entities.
The cervical region is the upper part of the spine found in the neck. MS lesions on the cervical spine can cause similar symptoms to when they appear in other areas, such as numbness, weakness, and balance issues. In addition, they can cause loss of sensation in both the shoulders and arms.
Although MRI is a very useful diagnostic tool, a normal MRI of the brain does not rule out the possibility of MS. About 5 percent of people who are confirmed to have MS do not initially have brain lesions evidenced by MRI.
MS lesions are present throughout the spinal cord, and spinal cord MRI may play an important role in the diagnosis and follow-up of MS patients.
People should consider the diagnosis of MS if they have one or more of these symptoms: vision loss in one or both eyes. acute paralysis in the legs or along one side of the body. acute numbness and tingling in a limb.
Magnetic resonance imaging (MRI)
It's very accurate and can pinpoint the exact location and size of any inflammation, damage or scarring (lesions). MRI scans confirm a diagnosis in over 90 per cent of people with MS.
You might get a shocking, burning, squeezing, stabbing, cold, or prickly feeling out of nowhere. Some people call them zingers or stingers. These zaps usually last only seconds or minutes. They often affect your legs, feet, arms, and hands.
Over 25,600 people in Australia are living with multiple sclerosis, including 3,700 Queenslanders, and it affects each person differently. On average more than 10 Australians are diagnosed with MS every week.
While there is no definitive blood test for MS, blood tests can rule out other conditions that cause symptoms similar to those of MS, including lupus erythematosis, Sjogren's, vitamin and mineral deficiencies, some infections, and rare hereditary diseases.
US researchers have studied the development of new MRI lesions in 36 people with MS and correlated these with stressful life events. After major life stresses, people were roughly 1.6 times more likely to develop a new lesion in the next eight weeks.