A 31-Year-Old Woman With Right Arm Tremors

Heidi Moawad, MD


May 01, 2019

The patient had brain MRI with contrast, which showed three lesions, two of which were described as small demyelinating lesions in the left subcortical white-matter region and one in the right cerebellum. Similar findings are shown in Figure 1.

Figure 1. Axial T2-weighted MRI images of the infratentorial region from three unique patients demonstrating foci of T2-hyperintensity at the brainstem (A), bilateral cerebellar lobes (B), and brainstem and bilateral cerebellar peduncle regions (C). A sagittal T2-weighted MRI image of the cervical spinal cord reveals multifocal regions of T2-hypertensinsity within the parenchyma (D). Image from the National Institute of Health’s US National Library of Medicine

She also had lumbar puncture, which showed oligoclonal bands and a high protein level (Figure 2).

Figure 2. Immunodetection of oligoclonal bands (OCBs) in serum and cerebrospinal fluid (CSF) of patients with multiple sclerosis. Pattern 1: OCBs in CSF only (positive). Pattern 2: No OCBs seen (negative, polyclonal). Pattern 3: Identical OCBs in both (mirror). Pattern 4: Identical OCBs in both, with extra in CSF. Image from the National Institute of Health’s US National Library of Medicine


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