Abstract Background and Purpose: To determine retrospec-tively the variation in regional involvement of brain among established cases of MS Canadian and Pakis-tani nation. We also analyzed parahippocampal gyrus lesions with further characterization according to grey white matter distribution. Methods: Sixty patients presenting clinically with multiple sclerosis were included as two groups of thir-ty each from Canadian and Pakistani nation respect-tively. Imaging was performed on 1.5 T MR system acquiring T 1 W, T 2 W, Proton density, FLAIR and T 1 W post gadolinium sequences. Lesions were counted and classified according to anatomic regions paraventri-cular, temporal lobe and juxtacortical. The juxtacorti-cal involvement of parahippocampal region consider-ing brain parenchymal involvement were classified. Zaidi N.R. 1 Former Professor of Radiology KEMU / Mayo Hospital, Lahore Ahmad M.W. 2 Medical Officer Department of Radiology, Mayo Hospital, Lahore Mehboob R. 3 Assistant Professor Department of Pathology King Edward Medical University, Lahore Results: Canadians haved more disease load as com-pare to Pakistani nation. Mean age of the patients are relatively younger in Canadians however anatomical lesional distribution in temporal lobe, paraventricular and parahippocampal region more or less same. Conclusion: Multiple sclerosis is more common amo-ng Canadian however its lesional anatomical distri-bution including parahippocampal region had no sig-nificant variation. Keywords: Multiple sclerosis (MS), Periventricular (PVC), Temporal lobe, Juxtacortical (JC) and Para-hippocampal.