Multiple sclerosis with megacystic presentation: A case report

Abstract

Multiple sclerosis is a frequent condition where the diagnosis relies on clinical presentation, neurologic examination, cerebro spinal fluid markers, and diagnostic imaging tests; however, atypical variants of the disease can lead to misdiagnosis in some scenarios. Herein, we describe a case of a 24-year-old patient with multiple sclerosis with megacystic plaques, in which appropriate interpretation of the imaging findings lead to a proper diagnosis and treatment.

Keywords: Atypical inflammatory demyelinating disorders; CT, Computed Tomography; MRI, Magnetic Resonance Imaging; MS, Multiple Sclerosis; Magnetic resonance imaging; Megacystic; Multiple sclerosis; NAA, N-Acetyl Aspartate.

Fig. 1

Axial (A) and coronal (B) non contrast brain CT images showed an expansile cystic lesion (star) with a maximum diameter of 3cm centered in the right frontal lobe without associated edema.

Fig. 2

Brain MRI and MR spectroscopy. Axial T2W (A), axial FLAIR (B), and axial T1W post gadolinium (C) images show a high T2 signal oval lesion in the right inferior frontal gyrus involving the juxtacortical white matter without associated edema and open ring enhancement (green arrows). Notice the enhancing T1 and FLAIR high signal lesion in the periventricular white matter (white arrows). Axial and sagittal FLAIR images (D and F) demonstrate multiple high signal foci in the periventricular white matter (orange arrows). MR Spectroscopy (E) shows a slight reduction in NAA and an increase in lactate, lipids, and choline without significantly altering the relationship of Choline/NAA.