Unilateral progressive brain lesions confirmed as multiple sclerosis

Multiple sclerosis (MS) often demonstrates highly variable clinical course and some heterogeneity in histopathology [1]. The diagnosis of MS is based on a classic history and symptoms and/or typical findings on magnetic resonance imaging (MRI). Newer MRI techniques, such as MR spectroscopy (MRS) promise to yield important information regarding MS recognition, prognosis, and treatment effects [2]. We report a case of MS confirmed by brain biopsy, that did not fulfill McDonald’s criteria [3]. Our patient at the age of 19 had her first episode of seizures (initially adverse, later on grand-mal epilepsy). Physical examination was normal, whilst neurologic examination demonstrated four-limb hyperreflexia, bilaterally presented Babinski’s sign and clonus. MRI revealed the presence of few T2 hyperintensities in the periventricular region, two lesions within the corpus callosum, as well as few cortical–subcortical lesions limited to the right hemisphere (Fig. 1a). Vasogenic brain lesion and symptomatic epilepsy was diagnosed. MRI scans, performed 6 months and 3 years later, revealed minimal or even no changes when compared with the previous one. At the age of 24, emotional disturbances were present (panic disorder, generalized anxiety disorder) and the patient was hospitalized in Psychiatric Department. One year later, the occurrence of seizures had increased and she started complaining of left limb weakness. At this time she was admitted to our Department. Neurologically, a slight upper left limb paresis with pyram-