The diagnosis of multiple sclerosis requires evidence for dissemination in space. This finding is lacking in a patient with solitary sclerosis where the lesion may be spatially isolated for a long time..
Clinical findings:
(1) progressive myelopathy with neurologic deficit
(2) single, spatially isolated demyelinating plaque, typically in the brainstem or upper cervical spinal cord
On MRI the lesion is/does/has:
(1) circumscribed
(2) not longitudinally extensive
(3) T2 hyperintense
(4) not occupy the entire cord or medulla
(5) no or minimal mass effect
The condition may be:
(1) misdiagnosed as a glioma or other low-grade tumor.
(2) misdiagnosed if studies to establish a diagnosis of inflammatory demyelinating disease are not performed.
Additional asymptomatic lesions may be detected if specialized or repeated imaging studies are performed.
