MRI brain in a 35-year-old woman shows multiple ovoid periventricular T2/FLAIR hyperintense lesions perpendicular to the corpus callosum ('Dawson fingers'), juxtacortical lesions, and one infratentorial lesion. One lesion shows ring enhancement. These findings are MOST consistent with:
- A Primary CNS vasculitis
- B Neuromyelitis optica spectrum disorder (NMOSD)
- C Multiple sclerosis (relapsing-remitting pattern) ✓
- D CADASIL (cerebral autosomal dominant arteriopathy)
Explanation
Dawson fingers (periventricular ovoid lesions perpendicular to the corpus callosum/lateral ventricles), juxtacortical and infratentorial lesions, and an open-ring or incomplete ring enhancement of an active plaque are hallmark features of multiple sclerosis on MRI. The McDonald 2017 criteria require dissemination in space (DIS) and time (DIT) based on MRI findings. NMOSD typically shows long spinal cord lesions (>3 vertebral segments) and area postrema lesions. CADASIL shows prominent white matter changes predominantly in the temporal poles and external capsules. CNS vasculitis shows microinfarcts at grey-white junction.
Reference: Grainger & Allison's Diagnostic Radiology, 7th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.