Authors
Amytice Mirchi, Arastoo Vossough, Grant T Liu, Sona Narula
Published in
Neurology. Volume 107. Issue 1. Pages e218254. Jul 14, 2026. Epub Jun 19, 2026.
Abstract
Recognition of radiologic lag, the presence of clinical symptoms despite absence of a visible corresponding lesion on MRI, is essential when evaluating a patient suspected to have a demyelinating disease. In this report, we present the case of a 16-year-old girl with bilateral internuclear ophthalmoplegias (INO), in whom initial high-resolution 3T MRI failed to reveal an abnormality within the brainstem. Repeat MRI performed 2 months later demonstrated a lesion in the paramedian midbrain tegmentum, corresponding to the anatomical localization of her clinical symptoms. This case aims to raise awareness that radiologic lag can occur in pediatric-onset multiple sclerosis, similarly to what has been described in other demyelinating conditions such as myelin oligodendrocyte glycoprotein antibody-associated disease. The absence of a visible lesion on imaging in the context of an acute INO does not exclude the possibility of underlying demyelination, and short-interval follow-up imaging should be considered in these patients to establish the correct diagnosis and guide additional investigations and treatment.
PMID:
42320011
Bibliographic data and abstract were imported from PubMed on 20 Jun 2026.
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