Multiple sclerosis lesions on magnetic resonance imaging, their characterization and pathological correlation with musculoskeletal disability in Pakistanis

Abstract

Background: Multiple sclerosis (MS) is an inflammatory disease affecting movement. MS has a worldwide distribution. Objectives: Early detection of MS lesions in Pakistanis by magnetic resonance imaging (MRI); to describe characteristics and to determine the association with musculoskeletal disability. Methods: We included 100 patients (18-65 years old) diagnosed with cases of MS from March 2012 to March 2013. A detailed clinical history of the musculoskeletal system was taken and MR imaging was performed to characterize lesions acquiring T1-weighted (T1W), T2W, proton density, fluid-attenuated inversion recovery(FLAIR), and T1W postgadolinium sequences. Results: Most patients belonged to a middle-aged group (42-62 years) and MS was common in women. MS lesions were found in the deep white matter of central nervous system (95 patients), supratentorially (97), periventricularly (96), juxtacortically (62), infratentorially (16), and in the temporal lobes (9). T2W sequences (99 patients detected) were superior to T1W sequences (47). By contrast, FLAIR sequence was more accurate and 100% of these cases were detected on this sequence of MRI. Muscle spasticity was found in 10 patients, muscle weakness in 53, uncoordinated movements in 7, ataxic gait in 9, and slurred speech in 3. However, numbness remained the more common clinical history (69 patients). Muscle fatigue (19), hemiparesis (8), and monoparesis in either upper and lower limbs (5) were other clinical presentations. Conclusions: MRI plays a pivotal role in detection and characterization of MS plaques. Clinical manifestations and imaging findings are similar to those reported from other parts of the world. Keywords: Ataxia, FLAIR, MRI, multiple sclerosis, muscle weakness, spasticity, T1W1, T2WI