Introduction
Background
Multiple sclerosis (MS) is considered the most common demyelinating process involving the central nervous system (CNS).1 In 1988, MS was first described in the upper cervical spine using magnetic resonance imaging (MRI). Spinal MS is often associated with concomitant brain lesions; however, as many as 20% of patients with spinal lesions do not have intracranial plaques. No strong correlation has been established between the extent of the plaques and the degree of clinical disability.
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Sagittal, T2-weighted image showing areas of signal hyperintensity in the cervical spinal cord and pons. Same patient as in Images 4-5.
Corresponding axial, T2-weighted image showing a large area of signal hyperintensity in the right lateral aspect of the cord. Same patient as in Images 3 and 5.
Sagittal, T1-weighted image following gadolinium contrast showing arciform enhancement along the edge of the plaque, typical of demyelination. Same patient as in Images 3-4.
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Pathophysiology
The exact cause of MS remains unclear; however, hypotheses include viral and autoimmune etiologies.
In the acute stage, perivenular inflammation with hypercellularity (macrophages and/or lymphocytes) is encountered in typically well-demarcated areas of demyelination.
In the chronic stages of the disease, fibrillary gliosis occurs with a breakdown of myelin. The axonal structure is conserved, with a reduction or absence of oligodendroglia. Occasionally, lesions resolve incompletely, but most progress to demyelination.
Frequency
United States
There are an estimated 250,000-350,000 patients in the United States with MS.
International
Multiple sclerosis (MS) occurs worldwide.2 Its prevalence varies depending on the geographic location, rising as the northerly or southerly distance from the equator increases. Depending on the country or the specific population, the prevalence of MS ranges from 2 cases per 100,000 population to 150 cases per 100,000 population.
Mortality/Morbidity
- The morbidity and mortality rates related to multiple sclerosis (MS) are high worldwide.
- At 15 years after the onset of the disease, an estimated 50% of patients need help with ambulation.
Race
Epidemiologic series have shown that western Europeans living in temperate zones have a higher risk for MS than do other groups.
Sex
The male-to-female ratio is 2:3.
Age
MS frequently occurs in persons aged 10-50 years. However, MS has also been described in the pediatric population and in individuals older than 50 years.
Anatomy
Spinal MS has a predilection for the cervical spinal cord (67% of cases), with preferential, eccentric involvement of the dorsal and lateral areas of the spinal cord abutting the subarachnoid space around the cord. The gray matter may be involved. Approximately 55-75% of patients with MS have spinal lesions at some point during the course of the disease.
Presentation
The clinical signs vary depending on the spinal cord segment affected and the degree of involvement. MS is characterized by a typical relapsing-remitting clinical course. Spastic paraparesis/paraplegia with neurogenic bowel and bladder, as well as with sexual dysfunction, can be encountered. Dysesthetic pain syndromes may result from spinal or cranial nerve root involvement.
Heredity is suggested to be involved in the etiology of the disease because affected relatives occasionally are identified.
A concomitant presence of optic neuritis (unilateral, bilateral, or chiasm) constitutes Devic neuromyelitis optica. The brain is usually normal, but the condition is associated with a poor prognosis.
MS can be seen with Leber hereditary optic neuropathy, which is called Harding's syndrome.3
Preferred Examination
Although nonspecific, MRI is presently considered to be the most sensitive diagnostic imaging modality for revealing demyelinating plaques. MRI shows abnormalities in 95% of patients with clinically definitive MS.4,5
Limitations of Techniques
MRI is sensitive to areas of demyelination, which appear as high signal areas on long TR sequences. Lesions of other etiologies (eg, viral myelitis, acute disseminated encephalomyelitis [ADEM]) may resemble MS plaques and must be considered along with the clinical history and the patient's presenting signs and symptoms.
Differential Diagnoses
Sarcoidosis
Systemic Lupus Erythematosus
Other Problems to Be Considered
Spinal cord tumors (primary or metastasis)
Infection (particularly viral, eg, cytomegalovirus, herpes, human immunodeficiency virus [HIV])
Acute transverse myelitis (history of recent viral infection or vaccination)
Acute spinal cord infarction (acute presentation)
Radiation myelitis (generally doses >4000 cGy; 1- to 3-y latency period; chemotherapy may be synergistic)
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References
Noseworthy JH, Lucchinetti C, Rodriguez M, et al. Multiple sclerosis. N Engl J Med. Sep 28 2000;343(13):938-52. [Medline].
Rosati G. The prevalence of multiple sclerosis in the world: an update. Neurol. Sci. 2001;22 (2):117–39. [Medline].
Parry-Jones AR, Mitchell JD, Gunarwardena WJ, et al. Leber's hereditary optic neuropathy associated with multiple sclerosis: Harding's syndrome. Pract Neurol. Apr 2008;8(2):118-21. [Medline].
Grossman RI, Yousem DM. Neuroradiology: The Requisites. St Louis, Mo: Mosby-Year Book; 1994.
Rovira-Canellas A, Alonso-Farre J, Rio-Izquierdo J. [Magnetic resonance in the clinical and therapeutic follow-up of multiple sclerosis]. Rev Neurol. May 16-31 2000;30(10):980-5. [Medline].
Agosta F, Absinta M, Sormani MP, et al. In vivo assessment of cervical cord damage in MS patients: a longitudinal diffusion tensor MRI study. Brain. Aug 2007;130:2211-9. [Medline].
LM Tartaglino, DP Friedman, AE Flanders, et al. Multiple sclerosis in the spinal cord: MR appearance and correlation with clinical parameters. Radiology. 1995;Vol 195:725-32. [Medline]. [Full Text].
Filippi M. Enhanced magnetic resonance imaging in multiple sclerosis. Mult Scler. Oct 2000;6(5):320-6. [Medline].
Grossman RI, Barkhof F, Filippi M. Assessment of spinal cord damage in MS using MRI. J Neurol Sci. Jan 15 2000;172 Suppl 1:S36-9. [Medline].
Henning A, Schär M, Kollias SS, et al. Quantitative magnetic resonance spectroscopy in the entire human cervical spinal cord and beyond at 3T. Magn Reson Med. Apr 17 2008;[Medline].
Marliani AF, Clementi V, Albini-Riccioli L, et al. Quantitative proton magnetic resonance spectroscopy of the human cervical spinal cord at 3 Tesla. Magn Reson Med. Jan 2007;57(1):160-3. [Medline].
Filippi M, Yousry TA, Alkadhi H, et al. Spinal cord MRI in multiple sclerosis with multicoil arrays: a comparison between fast spin echo and fast FLAIR. J Neurol Neurosurg Psychiatry. Dec 1996;61(6):632-5. [Medline]. [Full Text].
Hittmair K, Mallek R, Prayer D, et al. Spinal cord lesions in patients with multiple sclerosis: comparison of MR pulse sequences. AJNR Am J Neuroradiol. Sep 1996;17(8):1555-65. [Medline]. [Full Text].
Stevenson VL, Gawne-Cain ML, Barker GJ, et al. Imaging of the spinal cord and brain in multiple sclerosis: a comparative study between fast FLAIR and fast spin echo. J Neurol. Feb 1997;244(2):119-24. [Medline].
Filippi M, Bozzali M, Horsfield MA, et al. A conventional and magnetization transfer MRI study of the cervical cord in patients with MS. Neurology. Jan 11 2000;54(1):207-13. [Medline].
Finelli DA, Hurst GC, Karaman BA, et al. Use of magnetization transfer for improved contrast on gradient-echo MR images of the cervical spine. Radiology. Oct 1994;193(1):165-71. [Medline]. [Full Text].
Rocca MA, Mastronardo G, Horsfield MA, et al. Comparison of three MR sequences for the detection of cervical cord lesions in patients with multiple sclerosis. AJNR Am J Neuroradiol. Oct 1999;20(9):1710-6. [Medline]. [Full Text].
Poonawalla AH, Hou P, Nelson FA, et al. Cervical spinal cord lesions in multiple sclerosis: T1-weighted inversion-recovery MR imaging with phase-sensitive reconstruction. Radiology. Jan 2008;246(1):258-64. [Medline]. [Full Text].
Further Reading
Keywords
multiple sclerosis, spinal multiple sclerosis, multiple sclerosis of the spine, demyelinating process, brain lesions, spine lesions, perivenular inflammation, plaques, fibrillary gliosis, oligodendroglia, spinal MS, spinal multiple sclerosis, Devic neuromyelitis optica, optic neuritis






Overview: Multiple Sclerosis, Spine