Neuroimaging and the lesion of multiple sclerosis

In a patient with long-standing multiple sclerosis (MS), a double-dose delayed contrast-enhanced CT scan obtained during exacerbation revealed many areas of enhancement. Vigorous treatment with corticotropic hormone was followed by almost complete disappearance of these abnormalities. No areas of low attenuation were seen on a later unenhanced CT scan. Finally, MR imaging showed only a single area compatible with a plaque of MS. It is suggested that pathologic alteration of the blood-brain barrier seen in MS is not necessarily followed by demyelination and plaque formation. Restoration of the integrity of the blood-brain barrier may thus possibly prevent the formation of plaques in some MS patients, in particular if this can be accomplished early in the course of the exacerbation.