A "kissing lesion": In-vivo 7T evidence of meningeal inflammation in early multiple sclerosis.

BACKGROUND

The role of cortical lesions (CLs) in disease progression and clinical deficits is increasingly recognized in multiple sclerosis (MS); however the origin of CLs in MS still remains unclear.

OBJECTIVE

Here, we report a para-sulcal CL detected two years after diagnosis in a relapsing-remitting MS (RRMS) patient without manifestation of clinical deficit.

METHODS

Ultra-high field (7T) MR imaging using magnetization-prepared 2 rapid acquisition gradient echoes (MP2RAGE) sequence was performed.

RESULTS

A para-sulcal CL was detected which showed hypointense rim and iso- to hyperintense core. This was detected in the proximity of the leptomeninges in the left precentral gyrus extending to the adjacent postcentral gyrus.

CONCLUSION

This finding indicates that inflammatory infiltration into the cortex through the meninges underlies cortical pathology already in the early stage of disease and in mild disease course.