Presentation
Six month history of moderate headaches and blurred vision in both eyes, fundus examination revealed unexplained bilateral pale optic discs Intraocular pressure is normal in both eyes, cause? Rule out SOL
Patient Data
Widespread foci of high FLAIR signal in the deep white, juxtacortical and subcortical white matter of both cerebral hemispheres, many of which are perpendicular to the corpus callosum (Dawson's fingers).
Multiple similar foci in the cerebral hemispheres and cerebellum peduncles, more pronounced on the right.
No high signal foci in the optic nerve or chiasm. The pituitary gland is normal.
Case Discussion
The appearances are consistent with widespread demyelination.
Dawson's fingers are well illustrated.
On suspected MRI brain for demyelination, always check the optic nerves and any visualized cervical cord, as these are other potential sites for plaques.
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