Atypical imaging in children with multiple sclerosis – case presentation

Abstract

Atypical demyelinating lesions in multiple sclerosis (MS) (tumefactive demyelinating lesions, lesions with white matter cavitation, leukodystrophy-like lesions), although rare, pose serious differential diagnostic and therapeutic problems.
We present 3 clinical cases of children, one with Balo concentric sclerosis and two with multiple sclerosis (MS), who had atypical magnetic resonance findings during the course of the disease or during the initial clinical manifestation. The first patient presented with an acute hemiparesis and hemihypesthesia with MRI evidence of a rounded tumor-like periventricular lesion in the white matter with an alternating layers of high and low signal intensity, no mass effect and no perifocal edema. Given the imaging findings, a diagnosis of Balo concentric sclerosis was made. The second patient is a girl with MS in whom a tumor-like lesion was visualized on MRI during the second relapse. The third case is of a boy with a severe course of MS, with frequent relapses, in whom extensive leukodystrophy-like lesions with cavitation of the white matter were noted about 3 years after the disease onset.
The development of magnetic resonance imaging allows early and correct diagnosis of atypical imaging findings in MS. The presence of other lesions typical of MS as well as evidence of oligoclonal bands are risk factors for subsequent relapses. In cases in which the diagnostic criteria for MS are met, initiation of disease-modifying therapy is recommended.