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Images in Neurology
June 2004

Acute Demyelinating Disorder Appearing as Multiple Cystic Brain Lesions

Arch Neurol. 2004;61(6):966-967. doi:10.1001/archneur.61.6.966

A case of acute fulminant multiple sclerosis of the Marburg type is presented. Magnetic resonance imaging with gadolinium revealed cystic lesions with open ring enhancement and stereotactic brain biopsy results were consistent with acute demyelination. Extensive investigations excluded other etiologies.

An 18-year-old woman was initially seen with a 2-week history of generalized malaise, lethargy, and left arm weakness. She had no significant medical history or recent vaccinations and was not taking any medications. Neurological examination revealed only grade 4/5 left arm weakness. There were no visual, bulbar, sensory, cerebellar, or sphincter abnormalities. Routine blood test results were normal. A computed tomographic scan of the brain without contrast showed 4 large hypodense lesions with no midline shift (Figure 1). Investigations revealed no evidence of malignancy, vasculitis, ischemia, or infection (including human immunodeficiency virus). Magnetic resonance imaging with gadolinium confirmed the findings of multiple cystic lesions with incomplete ring enhancement (Figure 2).