Isolated neurological syndrome suggestive of MS: MRI evidence of Wallerian degeneration of the corticospinal tract

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Abstract

Wallerian degeneration is usually described in multiple sclerosis (MS) patients with severe disability and long-lasting disease, but it has also been recently reported in patients presenting with clinically isolated syndromes suggestive of MS. We report a 40-year-old woman who complained of a severe left hemiparesis. Brain MRI showed multiple T2-hyperintense white matter areas. One of these was a large lesion involving the posterior limb of the right internal capsule and the homolateral white matter of the corona radiata. CSF-OBs and serum autoantibodies were negative. A diagnosis of an isolated neurological syndrome suggestive of MS was made. Brain MRI performed after 5 months demonstrated an increase in the large right hemispheric lesion with a T2-hyperintense signal along the ipsilateral corticospinal tract, extending cranially to the juxtacortical white matter and caudally to the medulla ablungata. Eight months later we observed a shrinkage in the large T2-hyperintense area with the appearance of a T1-hypointense core. The corticospinal abnormal signal was less evident and extended, but a mild asymmetric atrophy of the brainstem was evident. Single voxel proton MR spectroscopy performed at this time revealed a reduction in N-acetyl aspartate, suggesting axonal degeneration, and a slight increase in inositol, usually associated with gliosis, along the corticospinal tract at the level of the corona radiata. The stability of a choline peak confirmed the end of demyelinating process. No new neurological symptoms were reported at follow-up and a severe left hemiparesis was still present. Wallerian degeneration along the corticospinal tract can occur after the appearence of a large inflammatory lesion involving the proximal axonal tract of the pyramidal cells.

Original languageEnglish
JournalNeurological Sciences
Volume21
Issue number4 SUPPL.
Publication statusPublished - 2000

ASJC Scopus subject areas

  • Clinical Neurology
  • Neuroscience(all)

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