From the Guidelines
Periventricular lesions in multiple sclerosis (MS) typically manifest as areas of demyelination around the ventricles of the brain, particularly adjacent to the lateral ventricles, and are characterized by cognitive impairment, fatigue, motor symptoms, sensory disturbances, and visual problems. The clinical manifestations of periventricular lesions in MS can be diverse, including:
- Cognitive impairment, especially affecting information processing speed and executive function
- Fatigue
- Motor symptoms such as weakness and spasticity
- Sensory disturbances including numbness, tingling, or pain
- Visual problems, with periventricular lesions near the optic radiations causing visual field defects
- Bladder and bowel dysfunction when lesions affect pathways controlling these functions On MRI, these lesions appear as hyperintense (bright) areas on T2-weighted and FLAIR sequences, often with an ovoid shape and orientation perpendicular to the ventricular surface (known as "Dawson's fingers") 1. The diagnosis of MS is supported by the presence of periventricular lesions, as they are included in the McDonald criteria and help distinguish MS from other white matter diseases 1. It is essential to distinguish periventricular lesions from other conditions, such as migraine, ischemic small-vessel disease, and neuromyelitis optica spectrum disorders, which can also present with similar lesions 1. The morphology of the lesions is crucial in diagnosis, with MS lesions often having an ovoid/round shape, whereas linear plate-like hyperintensities parallel to the body of the lateral ventricles (‘periventricular banding’ or ‘halo’) should not be considered indicative of MS 1. Red flags for periventricular lesions include the presence of lacunar infarcts or microbleeds, suggestive of ischemic small-vessel disease, or confluent and symmetric white matter abnormalities, indicative of genetic or metabolic leukodystrophies 1. The presence of three or more periventricular lesions is required to define the involvement of the periventricular region for disease dissemination in space (DIS) in MS diagnosis 1.
From the Research
Clinical Manifestations of Periventricular Lesions in Multiple Sclerosis (MS)
The clinical manifestations of periventricular lesions in MS can be understood by examining the characteristics and effects of these lesions.
- Periventricular lesions are a common feature of MS, often observed in the periventricular region of the brain 2.
- These lesions can lead to a range of clinical symptoms, including weakness, spasticity, fatigue, changes in sensation, coordination, vision, cognition, and bladder function 3.
- The presence of periventricular lesions can also contribute to balance and gait dysfunction, with many people with MS experiencing impaired postural control and gait 3.
- The location and characteristics of periventricular lesions can help differentiate MS from other neurological diseases, such as neuromyelitis optica spectrum disorders (NMOsd) 4.
- However, periventricular lesions are not specific to MS and can also be found in other conditions, including stroke and migraine 5.
Lesion Characteristics and Distribution
The characteristics and distribution of periventricular lesions in MS can provide insight into the clinical manifestations of the disease.
- Periventricular lesions are often characterized by a jagged-bordered pattern on axial FLAIR images, and the presence of "Dawson's fingers" on sagittal FLAIR images 4.
- The volume of periventricular lesions can be significant, with a mean volume of 2287 µl/patient in one study 2.
- The distribution of periventricular lesions can vary, but they are often found adjacent to the body and posterior horn of the lateral ventricles 5.
Diagnostic and Differentiating Value
Periventricular lesions can have diagnostic and differentiating value in MS.
- The presence of periventricular lesions is part of the revised McDonald MS diagnostic criteria 5.
- The characteristics and distribution of periventricular lesions can help differentiate MS from other neurological diseases, such as NMOsd 4.
- However, periventricular lesions are not specific to MS and can also be found in other conditions, including stroke and migraine 5.