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Updated: May 23, 2026
Comprehensive Autopsy Program for Individuals with Multiple Sclerosis
Published on: July 19, 2019
Acute demyelinating lesions with restricted diffusion in multiple sclerosis
Konstantin E Balashov1, Eric Lindzen
1Department of Neurology, UMDNJ, Robert Wood Johnson Medical School, New Brunswick, NJ 08901, USA. kbalashov@yahoo.com
Background And Objectives:
It is widely accepted that typical acute demyelinating lesions in relapsing-remitting multiple sclerosis (RRMS) exhibit vasogenic edema with increased diffusion, as demonstrated by an increased apparent diffusion coefficient on MRI. In contrast, acute ischemic lesions demonstrate cytotoxic edema with restricted diffusion. Recent reports have documented selected cases of acute demyelinating lesions exhibiting restricted diffusion (ADLRD) in MS. We aimed to assess the morphologies, distributions, signal characteristics and changes over time of nine ADLRD. An additional goal was to obtain clinical correlations and relate our findings to all previously published case reports describing ADLRD.
Methods:
A retrospective case series study was performed at two academic centers. MRI characteristics of nine ADLRD found in six RRMS patients were compared with typical active symptomatic contrast-enhancing lesions with increased or normal diffusion in control RRMS patients.
Results:
The average size of ADLRD was not significantly different from typical lesions. A periventricular location and faint signal on T2-weighted images were significantly more common for ADLRD compared with typical lesions. Two patients with ADLRD on initial MRI exhibited new ADLRD on their follow up scans.
Conclusion:
Our results and review of prior published cases suggest that ADLRD represent a new variant of MS lesion. The restricted diffusion that is a characteristic of ADLRD on MRI is a new challenge in the differential diagnosis of stroke in young adults. The pathogenesis of ADLRD remains to be understood.
Insights
Acute demyelinating lesions exhibiting restricted diffusion (ADLRD) in multiple sclerosis (MS) may represent a new variant. These ADLRD present diagnostic challenges, particularly in differentiating from stroke in young adults.
Area of Science:
- Neurology
- Radiology
- Neuroimmunology
Background:
- Typical acute demyelinating lesions in relapsing-remitting multiple sclerosis (RRMS) show vasogenic edema and increased diffusion on MRI.
- Acute ischemic lesions typically present with cytotoxic edema and restricted diffusion.
- Recent reports indicate some acute demyelinating lesions in MS can exhibit restricted diffusion (ADLRD).
Purpose of the Study:
- To assess the morphology, distribution, signal characteristics, and temporal changes of nine ADLRD.
- To correlate clinical findings with ADLRD.
- To review previously published ADLRD case reports.
Main Methods:
- Retrospective case series conducted at two academic centers.
- Compared MRI characteristics of nine ADLRD in six RRMS patients.
- Controlled comparison with typical active, contrast-enhancing lesions in RRMS patients.
Main Results:
- ADLRD size was comparable to typical MS lesions.
- Periventricular location and faint T2-weighted signal were more common in ADLRD.
- Two patients developed new ADLRD on follow-up scans.
Conclusions:
- ADLRD appear to be a novel variant of MS lesions.
- Restricted diffusion in ADLRD poses a diagnostic challenge for stroke in young adults.
- The underlying pathogenesis of ADLRD requires further investigation.
