Acute Multiple Sclerosis With Contrast-Enhancing Plaques

In a case of clinically fulminant multiple sclerosis (MS), contrast-enhancing lesions were visible by computerized axial tomography (CT). The patient died less than three weeks after the study, making neuropathologic correlation possible. It appears that areas of contrast enhancement correlate in acute MS with early demyelinative lesions, and enhancement is related to breakdown of the blood-brain barrier. That such a disturbance is important in the pathogenesis of demyelination in MS has been suggested by other data as well. The characteristic CT findings of MS must therefore include enhancing lesions that reflect disease activity and that may be the only CT abnormality.