A 32-year-old woman with relapsing sensory symptoms and optic neuritis has MRI brain showing periventricular ovoid T2/FLAIR lesions perpendicular to the lateral ventricles. What is the name of this sign and what condition does it indicate?
- A Thumb print sign — ischaemic penumbra
- B Dawson's fingers — multiple sclerosis ✓
- C Leukoaraiosis — small vessel ischaemic disease
- D Bilateral lesion — NMOSD (neuromyelitis optica spectrum disorder)
Explanation
Dawson's fingers are periventricular demyelinating plaques that extend perpendicular to the ventricular surface along the course of medullary veins, seen best on FLAIR sagittal imaging in multiple sclerosis. The periventricular, juxtacortical, infratentorial, and spinal cord distribution forms the McDonald MRI criteria for MS diagnosis. NMOSD (AQP4-IgG positive) shows long-segment spinal cord lesions, area postrema lesions, and bilateral optic nerve involvement but periventricular finger-like plaques are characteristic of MS, not NMOSD. Leukoaraiosis is confluent deep white matter change from small vessel disease.
Reference: Grainger & Allison's Diagnostic Radiology, 7th ed.
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Written and medically reviewed by the StethoPrep medical team.