From the Guidelines
The spinal segments responsible for the presenting symptoms of multiple sclerosis (MS) would likely involve cervical and thoracic segments, given the symptoms of hand and finger tremors, lower limb heaviness, genital numbness, vision changes, constipation, and unilateral pain perception alterations.
Key Symptoms and Corresponding Spinal Segments
- Hand and finger tremors: C5-T1
- Lower limb heaviness: L2-S1
- Genital numbness: S2-S5
- Vision changes: not directly related to spinal segments, but can be associated with MS
- Constipation: S2-S5
- Unilateral pain perception alterations: varies depending on the specific location of the pain
Evidence-Based Rationale
The 2010 McDonald criteria and the MAGNIMS consensus guidelines 1 emphasize the importance of spinal cord imaging in the diagnosis of MS, particularly in patients with clinical features localized to the spinal cord. The guidelines recommend imaging of the entire spinal cord to increase confidence in lesion identification, as approximately 40% of spinal cord lesions are found in the thoracolumbar region 1.
Clinical Implications
In patients with a normal brain MRI and a limited cervical spine MRI (C1-C4), whole spinal cord MRI is recommended to meet DIS criteria and to rule out alternative cord pathology 1. The presence of a lesion in the spinal cord can contribute to both DIS and DIT, and the guidelines suggest that identical DIS and DIT MRI criteria used in MS should be applied for the evaluation of radiologically isolated syndromes (RIS) 1.
Important Considerations
It is essential to note that the diagnosis of MS requires a combination of clinical and radiological findings, and that no single test, including MRI, can provide a definitive diagnosis 1. The guidelines emphasize the importance of caution when applying the 2010 criteria solely at baseline in patients with uncertain diagnoses, and recommend serial evaluation to confirm new lesions over time 1.
From the Research
Spinal Segments Responsible for Presenting Symptoms
The presenting symptoms of multiple sclerosis (MS), including hand and finger tremors, lower limb heaviness, genital numbness, vision changes, constipation, and unilateral pain perception alterations, can be associated with lesions in various spinal segments. Given a normal brain Magnetic Resonance Imaging (MRI) and a limited cervical spine MRI (C1-C4), the responsible spinal segments may include:
- Cervical spinal cord (C5-T1) for hand and finger tremors, as lesions in this region can affect the corticospinal tracts and dorsal columns 2
- Thoracic spinal cord (T1-T12) for lower limb heaviness, genital numbness, and constipation, as lesions in this region can affect the spinal cord tracts and autonomic nervous system 2, 3
- Cervical and thoracic spinal cord (C5-T12) for vision changes, as lesions in these regions can affect the spinal cord tracts and brainstem connections 4
- Cervical and thoracic spinal cord (C5-T12) for unilateral pain perception alterations, as lesions in these regions can affect the spinothalamic tracts and dorsal columns 2, 3
Relationship Between Cervical and Thoracic Spinal Cord Lesions
Studies have shown that thoracic spinal cord lesions are influenced by the degree of cervical spine involvement in MS patients 2. The presence of cervical spine lesions increases the odds ratio of thoracic spine involvement, suggesting a potential relationship between the two regions. This relationship may be independent of brain findings or clinical features 2.
Importance of Spinal Cord MRI in MS Diagnosis and Monitoring
Spinal cord MRI is an important tool in the diagnosis and monitoring of MS, as it can provide valuable information on lesion location, size, and number 5, 4, 3. Advances in spinal cord MRI techniques, including high-resolution imaging at 7T, have improved the visualization of lesions and gray/white matter contrast 6. These advances may facilitate the use of spinal cord atrophy as an outcome measure in clinical trials and observational studies 3.