A 17-year-old male presented with sudden onset of persistent focal neurological symptoms. Magnetic resonance imaging (MRI) demonstrated a nonenhancing white matter lesion that appeared hyperintense on fluid-attenuated inversion recovery sequence and diffusion-weighted imaging, while hypointense on apparent diffusion coefficient mapping corresponding to the patient’s clinical features. A smaller subclinical lesion was also present. The patient’s history, radiographic findings, and initial hospital course including response to treatment appeared supportive of a stroke diagnosis. However, a rapid recovery from his severe neurological deficits and results of subsequent serologic testing strongly indicated a demyelinating condition. The onset of adolescent multiple sclerosis can present diagnostic and therapeutic challenges, especially when the initial demyelinating event resembles an acute stroke in clinical and radiographic presentation. Every effort should be made to distinguish these diagnoses as early as possible to ensure timely and appropriate management.
Renoux C., Vukusc S., Confavreux C.The natural history of multiple sclerosis with childhood onset. Clin Neurol Neurosurg. 2008;110(9):897-904.
2.
Hahn JS, Danieal P., Rensel M., Rao S.Differential diagnosis and evaluation in pediatric multiple sclerosis . Neurology. 2007;68(16 suppl 2):S13-S22.
3.
Hanh CD, Shroff MM, Blaser SI, Banwell BLMRI criteria for multiple sclerosis: evaluation in a pediatric cohort . Neurology. 2004:62(5):806-808.
4.
Callen DJA , Shroff MM, Branson HM, et al. MRI in the diagnosis of pediatric multiple scleorsis. Neurology.2009;72(11):961-967.
5.
Callen DJA , Schroff MM, Branson HM, et al. Role of MRI in the differentiation of ADEM from MS in children . Neurology.2009; 72(11):968-973.
6.
Rosso C., Remy P., Creange A., Brugieres P., Cesaro P., Hosseini H. Diffusion-weighted MR imaging characteristics of an acute strokelike form of multiple sclerosis. Am J Neuroradiol. 2006;27(5): 1006-1008.
7.
Castriota Scanderbeg A., Tomaiuolo F., Sabatini U., Nocentini U., Grasso MG, Caltagirone C.Demyelinating plaques in relapsing-remitting and secondary-progressive multiple sclerosis: assessment with diffusion MR imaging. AJNR Am J Neuroradiol . 2000;21(5):862-868.
8.
Chien D., Kwong KK, Gress DR, Buonanno FS, Buxton RB, Rosen BRMR diffusion imaging of cerebral infarction in humans. AJNR Am J Neuroradiol. 1992;13(4):1097-1102.
9.
Sevick RJ, Kanda F., Mintorovitch J., et al. Cytotoxic brain edema: assessment with diffusion-weighted MR imaging. Radiology. 1992;185(3):687-690.
10.
Mintorovitch J., Yang GY, Shimizu H., Kucharczyk J., Chang PH, Weinstein PRDiffusion-weighted magnetic resonance imaging of acute focal cerebral ischemia: comparison of signal intensity with changes in brain water and Na+, K(+)-ATPase activity . J Cereb Blood Flow Metab. 1994;14(2):332-336.
11.
Brunberg JA , Chenevert TL, McKeever PE, et al. In vivo MR determination of water diffusion coefficients and diffusion anisotropy: correlation with structural alteration in gliomas of the cerebral hemispheres. AJNR Am J Neuroradiol. 1995;16(2): 361-371.
12.
Schlaug G., Siewert B., Benfield A., Edelman RR, Warach S.Time course of the apparent diffusion coefficient (ADC) abnormality in human stroke. Neurology. 1997;49(1):113-119.
13.
Lansberg MG , Thijs VN, O’Brien MW, et al. Evolution of apparent diffusion coefficient, diffusion-weighted, and T2-weighted signal intensity of acute stroke. AJNR Am J Neuroradiol. 2001; 22(4):637-644.
14.
Eastwood JD , Engelter ST, MacFall JF, Delong DM, Provenzale JMQuantitative Assessment of the time course of infarct signal intensity on diffusion-weighted images. AJNR Am J Neuroradiol. 2003;24(4):680-687.
15.
Balasubramanya KS, Kovoor JME, Jayakumar PN, et al. Diffusion-weighted imaging and proton MR spectroscopy in the characterization of acute disseminated encephalomyelitis . Neuroradiology. 2007;49(2):177-183.
16.
Kuker W., Ruff J., Gaertner S., Mehnert F., Madder I., Nagele T. Modern MRI tools for the characterization of acute demyelinating lesions: value of chemical shift and diffusion-weighted imaging. Neuroradiology. 2004;46(6):421-426.
17.
Axer H., Ragoschke-Schumm A., Bottcher J., Fitzek C., Witte OW, Isenmann S. Initial DWI and ADC imaging may predict outcome in acute disseminated encephalomyelitis: report of two cases of brain stem encephalitis . J Neurol Neurosurg Psychiatry. 2005; 76(7):996-998.
18.
Oshita T., Oka M., Imon Y., et al. Serial diffusion-weighted imaging in MELAS. Neuroradiology. 2000;42(9):651-656.
19.
Wang XY, Noguchi K., Takashima S., Hayashi N., Ogawa S., Seto H.Serial diffusion-weighted imaging in a patient with MELAS and presumed cytotoxic edema. Neuroradiology. 2003; 45(9):640-643.
20.
Tavazzi E., Dwyer MG, Weinstock-Guttman G., et al. Quantitative diffusion-weighted imaging measures in patients with multiple sclerosis. Neuroimage. 2007;36(3):746-754.
21.
Harada M., Hisaoka S., Mori K., Yoneda K., Noda S., Nishitani J.Differences in wather diffusion and lactate production in two different types of postinfectious encephalopathy. J Magn Reson Imaging . 2000;11(5):559-563.
22.
Moseley ME, Cohan Y., Mintorovitch J., et al. Early detection of regional cerebral ischemia in cats: comparison of diffusion- and T2-weighted MRI and spectroscopy. Magn Reson Med. 1990; 14(2):30-346.
23.
Mikaeloff Y. , Adamsbaum C., Husson B., et al., and the KIDMUS Study Group on Radiology. MRI prognostic factors for relapse after acute CNS inflammatory demyelination in childhood. Brain. 2004;127(pt 9):1942-1947.
