Wedge-shaped medullary lesions in multiple sclerosis

Qiu, Wei; Raven, Sonja; Wu, Jing-Shan; Carroll, William M.; Mastaglia, Frank L.; Kermode, Allan G.

doi:10.1016/j.jns.2009.12.017

« Previous Next »Journal of the Neurological Sciences
Volume 290, Issue 1 , Pages 190-193, 15 March 2010

Wedge-shaped medullary lesions in multiple sclerosis

Wei Qiu
- Centre for Neuromuscular and Neurological disorders, University of Western Australia, Australia
- Department of Neurology, Sir Charles Gairdner Hospital, Queen Elizabeth II Medical Centre, Perth, Western Australia, Australia
- Department of Neurology, the Third Affiliated Hospital of Sun yat-sen University, Guangzhou, China
Sonja Raven
- Neurointerventional and Imaging Services of Western Australia, Perth, Western Australia, Australia
Jing-Shan Wu
- Centre for Neuromuscular and Neurological disorders, University of Western Australia, Australia
- Department of Neurology, Sir Charles Gairdner Hospital, Queen Elizabeth II Medical Centre, Perth, Western Australia, Australia
William M. Carroll
- Centre for Neuromuscular and Neurological disorders, University of Western Australia, Australia
- Department of Neurology, Sir Charles Gairdner Hospital, Queen Elizabeth II Medical Centre, Perth, Western Australia, Australia
Frank L. Mastaglia
- Centre for Neuromuscular and Neurological disorders, University of Western Australia, Australia
- Department of Neurology, Sir Charles Gairdner Hospital, Queen Elizabeth II Medical Centre, Perth, Western Australia, Australia
Allan G. Kermode
- Centre for Neuromuscular and Neurological disorders, University of Western Australia, Australia
- Department of Neurology, Sir Charles Gairdner Hospital, Queen Elizabeth II Medical Centre, Perth, Western Australia, Australia
- Corresponding author. Australian Neuromuscular Research Institute, Sir Charles Gairdner Hospital; Centre for Neuromuscular and Neurological Disorders, University of Western Australia, Queen Elizabeth II Medical Centre, 6009, Perth, WA, Australia. Tel.: +61 8 93881865; fax: +61 8 93882149.

Received 17 August 2009; received in revised form 18 October 2009; accepted 15 December 2009. published online 07 January 2010.

Abstract

Multiple sclerosis (MS) is a heterogeneous disease with variable clinical features and magnetic resonance imaging (MRI) findings. We report four MS cases with unusual wedge-shaped lesions in the paramedian ventral medulla oblongata demonstrated on MRI. The clinical features and MRI characteristics of the medullary lesions suggest an impairment of venous drainage. We propose that the formation of these wedge-shaped lesions may be related to the pattern of venous drainage in the ventral medulla and raised venous pressure due to chronic cerebrospinal venous insufficiency which has recently been described in MS.

Keywords: Multiple sclerosis, Medulla, MRI, Chronic cerebrospinal venous insufficiency