**6. Multiple sclerosis (MS)**

Multiple sclerosis (MS) is a neuroinflammatory disorder involving the spinal cord, optic nerve and brain, and is prevalent in young women. It takes relapse and remission courses. The characteristic finding is multiple lesions in the brain and spinal cord observed on MRI [20]. Neuromyelitis optica (NMO) is a similar disease to MS, but usually long cord lesions (>3 vertebral body) are observed on spinal MRI, and autoantibodies against aquaporin 4 are usually detected in patients' sera [21, 22].

A 47-year-old woman was admitted to our hospital because of gait disturbance, clumsiness and numbness of the bilateral hands. Neurological examination revealed leg spasticity, increased deep tendon reflexes of all extremities, extensor plantar responses and sensory disturbances of the bilateral upper extremities and trunk. Spinal MRI showed a central cord lesion at C2-C3 with mild enhancement (**Figure 4**). Multiple ovoid periventricular lesions were observed on brain MRI. However, clinically spasticity was presented in the clinical examination in the lower legs only. The anti-aquaporin 4 antibody was not detected in her serum. We started high-dose methylprednisolone pulse therapy and subsequently administered oral fingolimod for relapse prevention. Her symptoms gradually improved except for the leg spasticity. Then we tried to treat her with botulinum toxin injection to her legs and gait rehabilitation [2]. The modified Ashworth score for her legs improved from 3 to 2.

**Figure 4.** Spinal MRI of the multiple sclerosis patient. T2: T2 weighted image; central cord lesion in C2-C4 (arrow). T1 Gd: T1 weighted gadolinium enhancement; mild enhancement of C2-C3 lesion (arrow).
