Abstract

The “eye-of-the-tiger sign” is described in some neurodegenerative diseases and defined as a hypointense ring surrounding a focus of high signal intensity in the globus pallidus on T₂-weighted (T₂WI) magnetic resonance imaging (MRI) due to iron accumulation. To our knowledge, there is no study in the literature describing “eye-of-the-tiger sign” in multiple sclerosis (MS). In this article, we discuss the “eye-of-the-tiger sign” in the T₂WI MRI of a case diagnosed with MS. A 54-year-old female patient admitted to our clinic with a complaint of difficulty in walking. She had a history of numbness and tingling in the left arm and leg, which started five years ago and a progressive problem in balance and gait that started two years ago. The patient’s extremities were both spastic and rigid. Her left upper extremity movements were moderately slow. The patient had proprioception loss in the lower extremities. Brain T₂WI MRI revealed “eye-of-the-tiger sign” and hyperintense white matter lesions consistent with demyelinization. Cervical spinal T₂WI MRI showed hyperintense lesions at C5 and C7 vertebral levels. The patient’s cerebrospinal fluid was positive for oligoclonal bands and she had increased latency of visual evoked potentials. In this article, we have emphasized that focal iron accumulation in the brain of a case with MS may appear as a “eye-of-the-tiger sign” on T₂WI MRI evaluation.