MS brain lesions: Causes, pictures, symptoms, and MRI detection

In the context of MS, a lesion refers to an area of damage in the brain.

This article examines what these lesions are, available treatments, and how MRI scans detect MS lesions. It also discusses how a person can prepare for an MRI scan.

Myelin sheaths cover the brain’s nerve fibers, which keep them insulated. In MS, chronic inflammation damages these myelin sheaths, which can result in brain lesions, also known as plaques.

Not all brain lesions are necessarily due to MS, but research shows that certain lesions are particularly characteristic of the condition.

Periventricular lesions are white matter lesions in direct contact with the brain’s lateral ventricles. The lateral ventricles are two large cavities that contain cerebrospinal fluid.

Doctors may refer to white matter lesions perpendicular to the corpus callosum as Dawson’s finger lesions. The corpus callosum is a bundle of nerve fibers that connects the left and right brain hemispheres.

Juxtacortical lesions are in direct contact with the brain’s cortex. This is the outermost layer of the brain.

How an MS lesion looks depends on the type of MRI scan used to view the brain. Lesions may appear as bright or dark spots, and some brain lesions have darker outer edges that appear to expand.

Research from 2020 also shows MS lesions have an identifiable central vein, while other non-MS lesions do not.

The following pictures show what brain lesions may look like on an MRI scan.

MS symptoms vary depending on the location and severity of the lesions. Some lesion locations and the resulting symptoms include:

There is currently no cure for MS. Treatments can prevent or slow the progression of some types of MS and help manage symptoms. We explore some treatment options below.

Disease-modifying therapies

Disease-modifying therapies (DMTs) are an emerging type of medication that can help people with relapsing-remitting MS. They can reduce the number of relapses and help prevent or delay progression.

Current DMTs include:

• interferon beta-1a (Avonex, Rebif)
• interferon beta-1b (Betaseron, Extavia)
• glatiramer acetate (Copaxone, Glatopa)
• peginterferon beta-1a (Plegridy)
• teriflunomide (Aubagio)
• fingolimod (Gilenya)
• dimethyl fumarate (Tecfidera)
• cladribine (Mavenclad)
• siponimod (Mayzent)
• alemtuzumab (Lemtrada)
• ocrelizumab (Ocrevus)
• natalizumab (Tysabri)

Doctors must administer some of these drugs as injections or infusions, while people can take others orally. A person takes them whether or not they are experiencing any MS flares.

Treatments for flares

Other approaches can help with pain and other symptoms.

• Corticosteroids: These reduce nerve inflammation. They are not a long-term solution, but they can relieve symptoms of severe relapses, including vision loss and severe weakness. Long-term use can cause side effects, including raised blood pressure, weight gain, and sleeping problems.
• Physical and other therapies: These can help a person stay mobile and active. In time, some people need help with daily tasks or benefit from using an assistive device, such as a wheelchair.
• Targeted symptom treatment: Various treatments can manage a range of issues, including:
  • urinary problems
  • sexual health issues
  • itchiness
  • fatigue

Plasma exchange

A plasma exchange, or plasmapheresis, involves removing and separating the liquid part of blood, known as plasma, from the blood cells.

A machine then mixes the blood cells with a protein solution and returns this to the body.

A doctor may recommend a plasma exchange when symptoms worsen or do not improve after treatment with corticosteroids.

MRI scans use a strong magnetic field and radio waves to produce two- or three-dimensional images.

The scans provide a significant amount of information that doctors use to diagnose MS and assess the status of people with the condition.

These scans can detect damage in the central nervous system, which comprises the brain and spinal cord. MS-related lesions appear on MRI images as either bright or dark spots, depending on the type of MRI scan.

This imaging technique is useful because it shows active inflammation and helps doctors determine the age of the lesions. Also, some specific types of lesions can indicate a flare-up of MS or damage in the brain.

It can be a good idea for anyone with MS to have periodic scans so that a doctor can assess the progression of the disease.

The frequency of scans will depend on a person’s disease course. For example, if a person’s MS is stable, they may only need periodic assessments, whereas someone with active MS needs more frequent scans.

There are two common types of MRI scans for the diagnosis of MS.

T1-weighted MRI scan

This provides information about the current status of MS. T1 scans can reveal chronic lesions that have links with neurodegeneration. The presence of chronic MS lesions in the brain has associations with disability and brain atrophy.

In a T1-weighted MRI scan, permanently damaged areas of the brain appear as dark spots or “black holes.”

The appearance of new or expanding lesions captured by a T1-weighted scan may indicate a progression of the condition.

T2-weighted MRI scan

This shows the number of old and new lesions in a specific part of the brain or spinal cord. It helps doctors determine the long-term effects of MS.

MS lesions appear as bright spots in a T2-weighted MRI scan. The appearance of more lesions on this type of scan may indicate higher levels of disability and a less favorable long-term outcome.

FLAIR sequencing

Fluid-attenuated inversion recovery (FLAIR) sequences are an advanced form of MRI that can improve lesion detection in combination with T2-weighted scans.

FLAIR sequences suppress cerebral fluid from scan outputs, allowing for clearer imaging.

Gadolinium contrast

Doctors may inject a gadolinium contrast agent into a person’s blood before an imaging scan. These agents appear on imaging scans and can help to highlight MS lesions.

Brain atrophy and volume

MRI scans can also assess brain volume and brain atrophy in people with MS. Brain volume refers to the size of a person’s brain, which is typically smaller in people with MS. In contrast, brain atrophy is the loss of connective neurons between brain tissue.

Before an MRI scan, people can eat and take their usual medications unless the doctor says otherwise. Inside the exam room, the person may need to change into a hospital gown.

It is important to remove any items that may affect the MRI machine, such as:

• eyeglasses
• hairpins
• watches
• jewelry
• dentures
• hearing aids
• wigs
• bras with underwires

MRI scans are not suitable in all cases. Doctors will not recommend MRI scans for anyone with the following:

• implantable cardiac devices, such as pacemakers
• implantable neurostimulation devices
• metallic fragments in their body
• metallic catheters
• cochlear and other ear implants
• magnetic dental implants
• drug infusion pumps

Before the scan, a healthcare professional may inject a chemical contrast dye, known as gadolinium, through an intravenous line into a vein in the person’s hand or arm. This improves the quality and accuracy of the images.

An MRI machine is a long, narrow tube. The person lies on a table that slides into the tube. A technician will monitor the examination process from a separate room.

During the scan, the inside of the machine makes loud, repetitive noises, such as tapping and thumping. The technician may provide earplugs or music to help block out the noise.

There is no cure for MS. On average, people with MS have a decreased life expectancy of around 7 years.

The severity and symptoms of MS vary from person to person, and symptoms can be unpredictable. A person can help manage their symptoms with stretching, light aerobic exercise, and dietary changes.

It is crucial to have a support network that understands what life with MS is like. Various organizations offer support groups and other resources.

In addition, Bezzy MS is a free app that provides support through one-on-one conversations and live group discussions. A person can download the app for iPhone or Android.

The following section covers some common questions about MS and brain lesions.

What do lesions on the brain mean for MS?

In MS, brain lesions may appear when chronic inflammation damages the myelin sheath that insulates nerve fibers in the brain. These lesions can cause a variety of symptoms depending on their severity and location.

Where do MS lesions first appear?

MS lesions can appear in the white and gray matter of the brain and spinal cord. Doctors can use imaging techniques, such as an MRI scan, to locate MS lesions.

Can MS brain lesions go away?

It is possible for some MS lesions to get smaller or disappear. In other cases, they may grow slowly but remain. Each case of MS is different.

That said, if a person’s lesions do not show up on a subsequent MRI, this does not mean their MS is in remission. There are also cases where symptoms are present and but lesions are not visible on imaging.

Can doctors cure MS brain lesions?

There is currently no cure for MS brain lesions. However, doctors may prescribe DMTs to reduce MS relapses and slow progression. Certain treatments, such as corticosteroids and physical therapy can also help to manage MS symptoms.

How many brain lesions are typical with MS?

On average, people with MS present with 10–15 lesions on the initial MRI scan.

Chronic inflammation from MS damages the myelin sheathes that cover nerves, causing lesions. These lesions can occur throughout the central nervous system, including the brain.

MS brain lesions can cause coordination problems, dizziness, slurred speech, muscular weakness, and sensation loss. The location of these lesions dictates which symptoms a person experiences.

There is no cure for MS, but several treatment modes can help people to manage the condition.

Read this article in Spanish.