Anti-Tumor Necrosis Factor Alpha-Associated Multiple Sclerosis
David S. Titelbauma,
Alexandra Degenhardtb and
R. Philip Kinkelb
a Department of Radiology, Shields Health Care, Brockton, MA
b Department of Neurology, Multiple Sclerosis Clinic, Beth Israel Deaconess Medical Center, Boston, MA
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FIG 1. A 33-year-old woman with longstanding RA on etanercept treatment, presenting with neurologic symptoms including body numbness and L’Hermitte sign.
A, Sagittal T2-weighted fat suppressed image of the left ankle shows severe peroneal tenosynovitis from the patient’s known RA.
B and C, Axial brain images from fluid-attenuated inversion recovery sequence reveal multifocal white matter lesions.
D, Midline sagittal proton attenuation weighted image of the cervical spine reveals large demyelinating lesions at the C2 and C5 levels.
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FIG 2. One year after discontinuation of etanercept, the patient developed new diplopia, gaze deficit, and left cranial nerve III palsy. Shown is an axial T2-weighted image at level of the midbrain, revealing a demyelinating lesion centered in the left periaqueductal region, in proximity to the oculomotor nucleus.
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AJNR - American Journal of Neuroradiology