Neuro-image: developmental venous anomaly and central vein sign in multiple sclerosis

Excerpt

A previously healthy 53-year-old woman presented to the emergency department with a 1-week history of a coordination disorder in the left leg. There was no other relevant personal or family history. Neurological examination revealed a mild appendicular ataxia of the left leg with a mild broad-based gait. 3T brain magnetic resonance imaging (MRI) demonstrated a right frontal white-matter lesion with open-ring gadolinium enhancement (Fig. 1). Susceptibility weighted imaging (SWI) showed prominent blood vessels in the surrounding brain parenchyma, with a hypointense vein running centrally through the hyperintense focal lesion, being compatible with a central vein sign (CVS) (Fig. 2). Furthermore, there were several periventricular white-matter lesions. Spinal cord MRI was unremarkable. Cerebrospinal fluid (CSF) analysis was normal except for one oligoclonal band that was not detected in the serum. The inflammatory and infectious laboratory work-up ruled out an alternative diagnosis. Based on the 2017 McDonald criteria, the diagnosis of relapsing–remitting multiple sclerosis (MS) was made.

…