Multiple sclerosis (MS) causes damage, called lesions, to parts of the central nervous system.

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MS is a neurological disease. It causes the immune system to attack and destroy myelin — protective fatty tissue that surrounds nerve cells.

This process, called demyelination, forms lesions in areas of the central nervous system, including parts of the brain and spinal cord.

This article reviews the link between multiple sclerosis and spinal lesions.

MS is an autoimmune disorder that affects the central nervous system. It causes the immune system to attack the protective layer of fat, called the myelin sheath, around nerve cells in the brain and spinal cord.

This slows down the nerves’ impulses, causing symptoms that may either worsen steadily (known as progressive) or come and go (known as relapsing-remitting).

The body may never fully repair the damage, which can lead to scarring. Damaged areas, called lesions, can occur in parts of the brain and spinal column.

Some people with MS have a stable condition, others experience symptoms that worsen rapidly, while some have symptoms that resolve spontaneously.

A person living with MS could experience a broad range of symptoms based on the number, location, and severity of the damage from the lesions. They can include vision issues, cognitive impairment, sensory problems, and mobility issues.

Doctors use various techniques to diagnose MS, including MRI scans and neurological exams.

They often find MS lesions in the periventricular white matter of the brain, the optic nerves, or the spinal cord.

A contrast MRI can help doctors discover if there are active lesions. These types of tests can help them determine if the lesions fit the criteria for diagnosing MS.

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The arrows are pointing to intramedullary lesions, or lesions, within the spinal cord. Intramedullary lesions can be caused by a tumor, infection, or inflammation, which is the cause in MS.
Yoon BN, Ha CK, Lee KW, Park SH, Sung JJ. A confusing case of multiple sclerosis and central nervous system graft versus host disease. Korean J Intern Med. 2016;31(5):995-998. doi:10.3904/kjim.2015.065

On their own, no symptoms, physical findings, or laboratory tests can point to MS.

For a doctor to diagnose the disease, they must find:

  • evidence of damage in at least two areas of the central nervous system — including the brain, spinal cord, or optic nerves
  • evidence that the damage occurred in different areas at different times
  • no indication that other issues, such as an infection or stroke, caused the lesions

In some cases, a person may have lesions on the brain or spinal cord before a diagnosis of MS. Both radiologically isolated syndrome (RIS) and clinically isolated syndrome (CIS) can involve lesions on the brain or spinal cord similar to MS.

RIS causes lesions in the brain or spine. CIS causes numerous MS-like neurological symptoms that in many cases are precursors to the development of full MS.

About 50% of people diagnosed with RIS go on to develop MS within 10 years. RIS does not have any symptoms and doctors do not consider it to be a cause of MS.

By contrast, about 6080% of people diagnosed with CIS who have lesions on the brain go on to develop MS. Unlike RIS, CIS is both a cause of MS and involves a neurological symptom due to inflammation of the central nervous system.

What do MS lesions look like on an MRI scan?

MS lesions may appear as either areas of gray, white, or black spots on an MRI, depending on whether they are new or old. The lesions are often oval or frame-shaped.

A doctor will look at all areas of the brain because the lesions can appear on either white or gray matter.

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In MS, the immune system attacks the myelin sheath that surrounds nerves to protect them. This causes inflammation, which leads to destruction of the myelin and nerves. These appear as lesions on an MRI, since there are areas where the myelin is now gone.
CAVALLINI JAMES/BSIP SA/Alamy Stock Photo

In order to better see the lesions, a doctor may use gadolinium, which is a contrasting dye. The dye helps the doctor to see the presence of active inflammation, or it increases the sensitivity and specificity of the MRI scan.

Learn more about MRI and MS here.

What do MS lesions on the spine look like?

According to a 2019 study, it can be difficult to image the spinal cord due to the potential of movement, such as from breathing. Lesions occur on both the gray and white matter or on just the gray matter.

Similar to lesions found on the brain, they can appear as areas of bright or dark spots on the spinal cord.

What is nuromyelitis optica?

Neuromyelitis optica, or Devic’s disease, is another demyelinating condition of the spine and optic nerve. In its early stages, it can be easily mistaken for MS due to similarities in symptoms. Both conditions can cause: myelitis — swelling and inflammation on the spinal cord; and optic neuritis — inflammation of the optic nerve that disrupts vision.

Doctors can use distinguishing features of neuromyelitis optica to rule out MS or vice versa. Signs of vision loss or other symptoms that may be the result of neuromyelitis optica include:

  • both spinal cord and optic nerve swelling that is more severe
  • a normal MRI of the brain
  • impact on vision affecting both eyes (with MS, only one eye is usually affected)
  • proteins called oligoclonal bands not present in the spinal fluid (they are usually present in cases of MS)

Lesions on the spine and brain indicate damage to the myelin that protects nerve cells. This is a sign of MS.

One function of myelin is to help the nerves send impulses. Without myelin, the nerves’ impulses travel more slowly.

In a 2018 study, researchers observed the patterns of lesions in the central nervous systems of people with either progressive or relapsing-remitting MS.

They demonstrated that people with primary progressive MS have more spinal cord lesions than brain lesions. The researchers also noted that those with more spinal cord lesions experienced greater physical disability.

In addition, the findings suggest that spinal cord involvement predicts worse neurological outcomes. The researchers also observed impaired repair mechanisms and recurrent demyelination in the spinal lesions.

A person’s symptoms depend on where MS lesions develop.

According to the National Multiple Sclerosis Society, symptoms of MS include:

  • pain and itching
  • numbness or tingling
  • weakness
  • fatigue
  • dizziness and vertigo
  • sexual dysfunction
  • trouble walking
  • spasticity
  • vision problems
  • bladder problems
  • bowel problems
  • behavioral and learning difficulties
  • depression

Less common symptoms include difficulties speaking, swallowing, and breathing.

Also, some people living with MS experience electrical sensations running through their spine and limbs.

No two people have the same combination of MS symptoms. Also, a person’s symptoms can change from day to day or from flare-up to flare-up.

Doctors can prescribe steroids to help reduce inflammation, which may reduce symptoms. However, this is not a cure, and it cannot prevent the symptoms from returning.

Another goal of MS treatment is to prevent further damage to nerve cells. Injectable, oral, and infusion medications can help slow the progression of the disease.

Some injectable treatments include interferon beta-1a, interferon beta-1b, and glatiramer acetate. Oral treatments include teriflunomide, fingolimod, and siponimod. Infusion medications include Tysabri, Ocrevus, and Lemtrada.

Anyone who believes that they are experiencing any symptoms of MS should see a doctor. Initial symptoms could involve unexplained weakness and sensory changes.

Receiving treatment early on could slow the progression of MS.

People experiencing mild flare-ups may not require medical attention as the symptoms could go away without treatment. However, anyone with more severe symptoms should see a doctor.

The following are answers to some commonly asked questions.

Can you have MS without lesions on the spine?

It is possible that a person may not have lesions on either the spine or brain during their initial diagnosis. However, the longer a person goes without developing a lesion, the more important it is for a doctor to rule out other conditions.

What are the symptoms of MS lesions on the cervical spine?

The cervical region is the upper part of the spine found in the neck. MS lesions on the cervical spine can cause similar symptoms to when they appear in other areas, such as numbness, weakness, and balance issues.

In addition, they can cause loss of sensation in both the shoulders and arms. For some, lesions on the cervical spine can lead to paralysis in all limbs.

What causes MS lesions?

MS causes the immune system to attack the myelin sheath that surrounds the brain and spinal cord. Over time, inflammation can cause damage and scarring. Doctors refer to damaged areas on the spine or brain as lesions or MS lesions.

Can you have MS lesions on the brain but not the spine?

It is possible that a person diagnosed with MS may have lesions on their brain but not on their spine. The opposite is also true. To avoid misdiagnosis, a person’s doctor will need to follow clinical guidelines to diagnose MS.

Multiple sclerosis is a complex disorder that involves the immune system attacking the protective coating of nerves, forming areas of damage called lesions.

A person living with MS may have lesions in parts of the brain, spinal cord, or optic nerve. Limited research suggests that having these lesions on the spine may lead to worse neurological outcomes of MS.

Symptoms of MS can differ from person to person and from day to day. A range of medications can help slow the progression of the disease, but there is no cure for MS yet.