Background: Large cavitary lesions are not typical for multiple sclerosis (MS). Cavitary white matter changes may be seen in megalencephalic leukoencephalopathy with subcortical cysts, Alexander disease, mitochondrial leukoencephalopathies, vanishing white matter disease, leukoencephalopathy with calcifications and cysts, cytomegalovirus infection, and cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy. Objective: To analyze clinical and radiological characteristics in MS patients with large cavitary lesions. Methods: We studied MS patients with large cavitary brain lesions. Patient characteristics, disease onset/duration/subtype, expanded disability status scale (EDSS), Mini Mental State (MMS), corpus callosum lesions, history of segmental myelitis, CSF oligoclonal bands (OCB), visual evoked potentials (VEP), vanishing white matter disease genetic analysis, and characteristics of the cavitary lesions were analyzed. Results: Nine patients were analyzed, 1 man and 8 women. Mean age of disease onset was 38.5 years. Mean disease duration was 9 years. Three patients had initial relapsing-remitting MS and 6 patients had primary-progressive MS. Mean EDSS was 4.5. Mean MMS was 20/30. Segmental myelitis was present in 6 cases. OCB were found in 6 patients. VEP was performed in 6 patients, and pathological in all but one. Vanishing white matter disease genetic analysis was performed and negative in 5 patients. Inferior corpus callosum lesions were seen in all patients with available sagittal FLAIR sequences. Cavitary lesions were strictly supratentorial, and located inside the diffuse leukoencephalopathy, with often a posterior predominance. Conclusion: MS patients with large cavitary lesions seem to represent an MS subgroup, predominantly women, with relatively late disease onset, predominantly primary-progressive type, relatively high EDSS scores, and severe cognitive dysfunction.

1.
Polman CH, Reingold SC, Edan G, et al: Diagnostic criteria for multiple sclerosis: 2005 revisions to the ‘McDonald Criteria’. Ann Neurol 2005;58:840–846.
2.
Renard D, Castelnovo G, Bousquet PJ, et al: Brain MRI findings in long-standing and disabling multiple sclerosis in 84 patients. Clin Neurol Neurosurg 2010;112:286–290.
3.
Naismith RT, Cross AH: Multiple sclerosis and black holes: connecting the pixels. Arch Neurol 2005;62:1666–1668.
4.
Barkhof F, McGowan JC, van Waesberghe JH, Grossman RI: Hypointense multiple sclerosis lesions on T1-weighted spin echo magnetic resonance images: their contribution in understanding multiple sclerosis evolution. J Neurol Neurosurg Psychiatry 1998;64(suppl. 1):S77–S79.
5.
Sahraian MA, Radue EW, Haller S, Kappos L: Black holes in multiple sclerosis: definition, evolution, and clinical correlations. Acta Neurol Scand 2010;122:1–8.
6.
Tam RC, Traboulsee A, Riddehough A, Sheikhzadeh F, Li DK: The impact of intensity variations in T1-hypointense lesions on clinical correlations in multiple sclerosis. Mult Scler 2011;17:949–957.
7.
Patrono C, Di Giancinto G, Eymard-Pierre E, et al: Genetic heterogeneity of megalencephalic leukoencephalopathy and subcortical cysts. Neurology 2003;61;534–537.
8.
Biancheri A, Rossi D, Cassandrini D, Rossi A, Bruno C, Santorelli FM: Cavitating leukoencephalopathy in a child carrying the mitochondrial A8344G mutation. Am J Neuroradiol 2010;31:E78–E79.
9.
Labauge P, Horzinski L, Ayrignac X, et al: Natural history adult-onset eIF2B-related disorders: a multicentric survey of 16 cases. Brain 2009;132:2161–2169.
10.
van der Knaap MS, Pronk JC, Scheper GC: Vanishing white matter disease. Lancet Neurol 2006;5:413–423.
11.
Labrune P, Lacroix C, Goutières F, et al: Extensive brain calcifications, leukodystrophy, and formation of parenchymal cysts: a new progressive disorder due to diffuse cerebral microangiopathy. Neurology 1996;46:1297–1301.
12.
Fazekas F, Chawluk JB, Alavi A, Hurtig HI, Zimmerman RA: MR signal abnormalities at 1.5 T in Alzheimer’s dementia and normal aging. AJR Am J Roentgenol 1987;149:351–356.
13.
Miura H, Mukoyama M, Kamei N: Multiple sclerosis with bilateral continuous cystic lesions along lateral ventricles and caudate-callosal angels (Wetterwinkel). Clin Neuropathol 1993;12:191–195.
14.
Brex PA, Ciccarelli O, O’Riordan JI, Sailer M, Thompson AJ, Miller DH: A longitudinal study of abnormalities on MRI and disability from multiple sclerosis. N Engl J Med 2002;346:158–164.
15.
Miller DH, Leary SM: Primary-progressive multiple sclerosis. Lancet Neurol 2007;6:903–912.
16.
Nijeholt GJ, van Walderveen MA, Castelijns JA, et al: Brain and spinal cord abnormalities in multiple sclerosis. Correlation between MRI parameters, clinical subtypes and symptoms. Brain 1998;121:687–697.
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.