Lesion Location in Multiple Sclerosis with All Four Limbs Paresthesias

Anatomical Basis for Four-Limb Paresthesias in MS

The dorsal columns of the spinal cord primarily transmit proprioception, vibration sensation, and fine touch information from the periphery to the brain 1
Lesions affecting the cervical spinal cord, particularly the dorsal columns, can cause paresthesias in all four limbs due to the anatomical organization of sensory pathways 2, 3
MS lesions in the spinal cord are often small, covering less than two vertebral segments and usually less than half of the cord area 4, 5

On axial MRI images, most MS spinal cord lesions are located in the periphery of the spinal cord, mainly in the lateral or dorsal columns 4, 5
MS lesions can affect both the anterior white matter and the central gray matter, but focal lesions strictly confined to the gray matter are unusual in MS 5
Typical MS spinal cord lesions are focal with clearly demarcated borders, cigar-shaped on sagittal images, and wedge-shaped on axial images 4, 5

The cervical portion of the spinal cord is more frequently involved in MS compared to thoracic or lumbar segments 3

MRI of the cervical spine is essential for evaluating patients with suspected MS presenting with four-limb paresthesias 2, 6
Key MRI sequences should include T2-weighted and T1 post-gadolinium images of the brain and spinal cord 2, 7
Axial imaging is particularly important to accurately localize lesions within specific spinal cord columns 3, 5

Longitudinally extensive transverse myelitis would suggest neuromyelitis optica spectrum disorder rather than MS 3
Selective involvement of lateral and posterior columns may indicate subacute combined degeneration rather than MS 1, 3
Diffuse spinal cord lesions with ill-defined borders should not be considered as supporting a diagnosis of MS 5