BACKGROUND Intracerebral cystic lesions can easily be identified by computed tomography (CT) and magnetic resonance imaging (MRI). Cystic gliomas, brain abscesses, or metastatic carcinoma are the usual underlying causes for this neuroradiologic finding. CASE PRESENTATION We report here the case of a patient with multiple sclerosis who has two intracerebral cystic lesions. CONCLUSIONS Central nervous system (CNS) tissue destruction, necrosis, and cyst formation are very unusual in multiple sclerosis. Diagnostic difficulty therefore arises when patients suspected of having multiple sclerosis have radiologic evidence of cystic CNS lesions.