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Dawson's fingers on MRI — SCE Neurology MCQ

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HardMSDawson's fingers on MRISCE Neurology

A 42-year-old woman presented with sensory symptoms and MRI lesions radiating perpendicular to lateral ventricles. On examination, examination showed reduced vibration and brisk reflexes. Initial investigations showed: T2 images showed ovoid perivenular lesions extending from calloso-septal interface. Where is the most likely anatomical localisation?

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Correct answer: C — periventricular white matter

periventricular white matter is the best answer because the vignette describes Dawson's fingers on MRI: Dawson's fingers are characteristic perivenular MS lesions. Optic nerve is plausible in a neighbouring presentation, but the chronology, examination or investigation pattern does not match the key discriminator here. Superior sagittal sinus and Contralateral internal capsule are less appropriate because they would require different localisation, timing or test findings; Dominant temporal lobe would fit a different syndrome. Clinical pearl: small-vessel disease lesions are usually punctate and deep rather than callosal-periventricular ovoid.

Reference: NICE NG220; ABN guidance on disease-modifying therapies for MS