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- Variant of multiple sclerosis
- Large demyelinated lesions with peculiar alternating layers of preserved and destroyed myelin
- Isolated, multiple or mixed with normal MS type lesions
- Similar lesions seen in cocaine abuse, an autoimmune reaction to levamisole – common cocaine adulterant
Imaging
- Thick concentric T2 hyperintense bands corresponding to demyelination and gliosis
- Isointense bands represent normal myelin
- Onion skin, mosaic or floral configuration
- Centre of lesion shows no layering – storm centre
- Inflammatory edge of lesion shows contrast enhancement and restricted diffusion
- Predominantly in cerebral white matter
- Brain stem, cerebellum and spinal cord involvement reported