Patient information ● Patient with MS ● Diagnosis in 2016 September ● Clinical worsening found in 2019 July ● Followup in 2020 January ● MRI, T1 sequence, FLAIR used MS diagnosis ● FLAIR MRI ○ Hypertension has been seen ■ Aligned in lateral ventricle (Dawson’s finger) ■ Near cortical grey matter ■ Demyelination in white matter ○ T1 sequence does not show any black holes ■ Chronic axonal loss ○ No active inflammation now ■ Contrast enhancement is not present ○ Mass effect and edema model is not visible at this point ● McDonald criteria ○ Dissemination in space ■ Multiple CNS regions involved ■ Implied form clinical history Interval imaging ● Increase in lesion ○ T2/FLAIR visible from 2016 ● Red ○ Periventricular lesion ● Green ○ Corpus callosum ○ Anterior deep white matter ● Blue ○ Cortical U-fiber ○ Cognitive impact ● Orange ○ Gray white matter ○ Cortical demyelination ■ Could be noticed as MS forms ● Yellow ○ Parietal association areas could be impacted ○ Posterior white matter lesions Follow up ● No new T2/FLAIR lesion are seen ● Stable in size, shape ● No black hole seen ○ No chronic axonal loss ○ No acute inflammatory demyelination ● Now only could be seen as Quiescent plaque ○ No mass effect ○ No perilesional edema