Multiple sclerosis (MS) is not only inflammatory and demyelinating disease of the central nervous system, but also degenerative one. It affects predominantly young people and has a chronic, often progressive and debilitating course. We searched hospital MS center database between the years 2008-2018 and focused on less common MS forms and complications of MS treatment.

PATHOLOGY, ETIOLOGY AND EPIDEMIOLOGY In May 1868, Jean Martin Charcot (1825–93) described ‘sclerosed plaques’ in the periventricular area, pons and spinal cord [1]. The characteristic pathological hallmark of MS is perivenular inflammatory lesions, resulting in demyelinating plaques [2]. New data shows that in patients with multiple sclerosis, mitochondrial dysfunction is at the root of pathological cascade leading to brain damage [3]. The exact etiology of MS is not fully understood, although epidemiological data suggests that genetic and environmental factors are important [4]. Genetic vulnerability is...

TYPICAL MRI FINDINGS Perivenular T2 hyperintense lesions in typical regions of the CNS - periventricular, juxtacortical U-fibers, infratentorial, spinal cord “Dawson's finger” sign (Fig. 1) Active lesion with pathological diffusion restriction According to the McDonald criteria, activity of the disease is sometimes evaluated with contrast enhancement on T1WI, although some recent publications suggest that DWI might replace contrast enhanced imaging (CE-MRI) in this regard. [11] Chronic or persistent T1-hypointense lesions (black holes) have been used as markers of axonal loss and neuronal destruction to measure...

MS is a disease of many faces. The diagnosis can be challenging and the findings quite vary on follow-up imaging. The risk of PML as a complication of treatment by natalizumab is higher in JCV positive patients, therefore a follow-up is recommended in these patients every 3 months with simplified MRI protocol. Immunocompromised patients on long term MS treatment may develop very rare complication in the form of PCNSL, with sole case in our department in the last 10 years.

M. Grilli Wagnerová; Prague/CZ - nothing to disclose H. Malikova; Prague/CZ - nothing to disclose

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