Causes | How It Causes Symptoms | Spine Lesions vs. Brain Lesions | Detection | Other Conditions | Prevention | Support

Lesions form in multiple sclerosis (MS) as a result of damage to the nerve cells in the central nervous system (CNS). These lesions can be found in the brain and spinal cord, depending on the type and severity of MS.

A diagnosis of MS requires the identification of at least two lesions in distinct areas of the CNS with damage that took place at different points in time. Any other diagnosis needs to be ruled out before an MS diagnosis can be made. Not all spine lesions are caused by MS.

Other conditions to rule out include:

• Other demyelinating disorders, such as neuromyelitis optica
• Brain or spinal cord tumors
• CNS infections, such as Lyme disease or HIV
• Other autoimmune diseases, such as Sjögren’s syndrome
• Vitamin B12 or copper deficiencies
• Structural damage to the brain or spinal cord

What Causes Spine Lesions?

In MS, the immune system attacks the protective coating on the outside of nerve cells (myelin). This damage leaves behind scar tissue that forms into lesions on the brain or spinal cord called plaques.

Spine lesions are common in people with MS. One study found that in 104 people recently diagnosed with MS, 83 percent had spine lesions.

Other causes of spine lesions can include:

• Neuromyelitis optica spectrum disorder (neurological disease that causes demyelination in the optic nerves, brain stem, and spinal cord)
• Dural arteriovenous fistulas (abnormal connections between veins and arteries around the brain or spinal cord)
• Neurosarcoidosis (an inflammatory disease of the CNS)
• Cancer
• Infections
• Trauma
• Congenital defects

Location of Spine Lesions

The spine contains 33 individual bones divided into five regions. Spine lesions in MS are typically found in the cervical region, which starts at the base of the head and continues through the neck. Occasionally, they can also be found in the thoracic region, which spans from the base of the neck through the mid-back. One study found that people with MS who have cervical lesions are more likely to also have thoracic spine lesions.

How Do Spine Lesions Cause MS Symptoms?

Spine lesions can cause nerve damage that leads to motor and sensory dysfunction. The loss of myelin around the spinal cord’s nerve cells slows down the electrical signals sent through the CNS, which can impair communication between nerves. Spinal cord wasting (atrophy), or the loss of white matter tissue (neurons and myelin) in the spinal cord, can also cause symptoms.

Nerve damage caused by MS can also cause altered sensations, a type of nerve pain. These occur because damaged nerves cannot properly send signals in the CNS. The brain tries to relate this nerve pain to other sensations, including:

• Tingling
• Burning
• Itching
• Crawling
• Numbness
• Electric shocks
• Pins and needles

Some MyMSTeam members also experience a pulsating sensation in the cervical spine, which may be potentially related to spine lesions. One member asked, “This might sound strange, but I have two lesions on my cord, one at the C2 and one at the C3. Sometimes I get a feeling that feels like they are ‘pulsating.’ Comes and goes. Anybody else ever have anything like that?” Other members agreed that they have also experienced this, describing vibrating sensations similar to a tuning fork.

How Do Spine Lesions and Brain Lesions Differ?

MS is characterized by the presence of lesions on the brain and spinal cord. People with primary progressive MS typically have more spinal cord lesions than brain lesions.

Brain and spine lesions also cause different symptoms. In MS, symptoms depend on the location of the lesion. For example, brain lesions can cause symptoms such as impaired coordination or vision problems. In contrast, spinal cord lesions can cause muscle weakness, numbness and tingling, and pain.

How Do Doctors Detect Spine Lesions?

The most common method for detecting lesions is through MRI. This is a highly sensitive imaging method that can take detailed pictures of the body’s organs and tissues. MRI scans use radio waves and magnetic fields to measure the water content in tissues.

Myelin is a fatty substance that repels water. Areas affected by MS do not have myelin. Therefore, these areas will fill with water and look abnormal on an MRI scan — and reveal any damage to the spinal cord. It is important to note that, unlike an X-ray, MRI does not involve any radiation.

MRI Techniques

Sometimes, radiologists will use gadolinium (a contrast agent) to help highlight new areas of inflammation in the spine. Under normal conditions, the blood-brain barrier protects the brain and spinal cord from harmful substances. Large molecules, such as gadolinium, would not be able to pass through this barrier. However, during times of active inflammation, the blood-brain barrier is compromised. This inflammation allows gadolinium to enter the CNS — and the scan to show areas of inflammation.

In an MRI scan, your radiologist and neurologist will look at different imaging sequences to determine the extent of the damage. Some common imaging sequences used to detect MS lesions and other abnormalities include:

• T-1 weighted sequence without gadolinium
• T-1 weighted sequence with gadolinium
• T-2 weighted sequences
• FLAIR (fluid-attenuated inversion recovery) sequence

The T-1 weighted sequence without gadolinium shows darker areas where nerves are permanently destroyed (areas with lesions and little to no myelin). The T-1 weighted sequence with gadolinium shows brighter areas of gadolinium where there is active inflammation (lesion enhancement).

The T-2 weighted sequence shows the overall disease impact and the total number of lesions. This sequence can show both new and old lesions at once. The FLAIR sequence can decrease imaging “noise” from the surrounding cerebrospinal fluid, which gives a clearer picture of the lesions.

Other Conditions With Spine Lesions

Demyelinating diseases all share common signs and symptoms caused by inflammation in the CNS. This can make diagnosing these diseases difficult. Doctors use the concept of a differential diagnosis to rule out other diseases before diagnosing MS. Some diseases that present with similar symptoms to MS include neuromyelitis optica spectrum disorder and transverse myelitis.

Neuromyelitis Optica Spectrum Disorder

Neuromyelitis optica spectrum disorder is a rare neurological disease characterized by demyelination in the optic nerves, spinal cord, and brain stem. It can cause optic neuritis (swelling and inflammation of the optic nerve), leading to vision problems.

The spinal cord can also be damaged, leading to muscle weakness, muscle spasms, and bladder and bowel dysfunction. These symptoms are all extremely similar to those of MS. However, MRI scans will mainly show spinal cord lesions, with few lesions in the brain.

Transverse Myelitis

Transverse myelitis (TM) is a demyelinating condition caused by inflammation on both sides of one spinal cord section. This causes similar symptoms to MS because the inflammation interferes with signaling between spinal cord nerves and other parts of the body.

A person with TM who has an abnormal brain scan showing more than two lesions has an increased risk of developing MS (up to 90 percent). TM is a relatively rare disease.

Preventing New or Worsening MS Lesions

Currently, there is no cure for MS. The U.S. Food and Drug Administration has approved many disease-modifying therapies (DMTs) that can slow the progression of MS by reducing both the number and severity of relapses.

Other MS medications are geared toward alleviating symptoms instead of stopping the progression of the disease. DMTs work in a few different ways, including:

• Reducing the amounts of certain immune cells involved in MS attacks
• Regulating immune cell function
• Reducing inflammation and demyelination

Talk With Others Who Understand

MyMSTeam is the social network for people with multiple sclerosis and their loved ones. On MyMSTeam, more than 187,000 members come together to ask questions, give advice, and share their stories with others who understand life with MS.

Are you living with multiple sclerosis? Do you have spine lesions from MS? Share your experience in the comments below, or start a conversation by posting on your Activities page.