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Updated: May 24, 2026
Comprehensive Autopsy Program for Individuals with Multiple Sclerosis
Published on: July 19, 2019
Open ring enhancement in atypical brain demyelination
Vijayakumar Javalkar1, Marc Manix, Jon Wilson
1Department of Neurosurgery, Louisiana State University Health Sciences Center, Shreveport, Louisiana 71103-33932, USA.
Abstract:
Open ring enhancement is considered highly specific for atypical demyelination. In this report we present a patient with a history of headache, ataxia and sensory disturbances in the lower extremities. A cranial MRI scan showed a large frontal lesion with mass effect, midline shift and with open ring enhancement. These findings are characteristics of tumefactive multiple sclerosis. Such lesions can be confused with neoplasms and abscesses. Open ring enhancement may help in differentiating atypical demyelination from a neoplasm or an abscess.
Insights
Open ring enhancement on MRI is specific for atypical demyelination. This case highlights its role in diagnosing tumefactive multiple sclerosis, differentiating it from tumors and abscesses.
Area of Science:
- Neurology
- Radiology
- Neuroimaging
Background:
- Atypical demyelination presents diagnostic challenges.
- Open ring enhancement is a key imaging finding.
- Differentiating demyelinating lesions from neoplasms and abscesses is crucial.
Observation:
- A patient presented with headache, ataxia, and lower extremity sensory disturbances.
- Cranial MRI revealed a large frontal lesion with mass effect and midline shift.
- The lesion exhibited characteristic open ring enhancement.
Findings:
- The observed imaging features are indicative of tumefactive multiple sclerosis.
- Open ring enhancement is a specific marker for atypical demyelination.
- This pattern aids in distinguishing tumefactive MS from other intracranial pathologies.
Implications:
- Open ring enhancement is a valuable sign in neuroimaging for diagnosing tumefactive MS.
- Accurate differentiation prevents misdiagnosis and guides appropriate treatment strategies.
- This finding underscores the importance of detailed MRI analysis in neurological assessments.
