Resolution of Left Hemisphere Cognitive Dysfunction in Multiple Sclerosis with Magnetic Resonance Correlates: A Case Report

Secondary paroxysmal dyskinesias (SPDs) are short, episodic, and recurrent movement disorders, classically related to multiple sclerosis (MS). Carbamazepine is effective, but with risk of adverse reactions. We identified 7 patients with SPD among 457 MS patients (1.53%). SPD occurred in face ( n = 1), leg ( n = 2), or arm +leg ( n = 4) several times during the day. Magnetic resonance imaging (MRI) showed new or enhancing lesions in thalamus ( n = 1), mesencephalic tegmentum ( n = 1), and cerebellar peduncles ( n = 5). Patients were treated with clonazepam and then acetazolamide ( n = 1), acetazolamide ( n = 5), or levetiracetam ( n = 1) with response within hours (acetazolamide) to days (levetiracetam). No recurrences or adverse events were reported after a median follow-up of 33 months.

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Detecting Cognitive Dysfunction in Multiple Sclerosis with a Magnetic Resonance Imaging Rating Scale: A Pilot Study

CNS Spectrums ◽

10.1017/s1092852900022768 ◽

2005 ◽

Vol 10 (5) ◽

pp. 394-402 ◽

Cited By ~ 7

Author(s):

Laury Chamelian ◽

Christian Bocti ◽

Fu-Qiang Gao ◽

Sandra E. Black ◽

Anthony Feinstein

Keyword(s):

Magnetic Resonance Imaging ◽

Multiple Sclerosis ◽

Cognitive Impairment ◽

Magnetic Resonance ◽

Cognitive Dysfunction ◽

Rating Scale ◽

Brain Mri ◽

Lesion Score ◽

Resonance Imaging ◽

Hyperintense Lesion

AbstractObjective: In multiple sclerosis (MS), magnetic resonance imaging (MRI) predictors of cognitive impairment are based on sophisticated computer-generated analyses that are difficult to apply in clinical settings. This study investigated the clinical usefulness of a new visual rating scale, the Cholinergic Pathways Hyperintensities Scale (CHIPS), in detecting cognitive dysfunction.Methods: Forty clinically definite MS patients underwent a brain MRI. Based on the CHIPS, cholinergic pathway hyperintensities were rated in 10 regions on four axial slices. Computerized hyperintense lesion volumes were also obtained. For cognitive testing, The Neuropsychological Screening Battery for Multiple Sclerosis was used. “Low” and “High” lesion score groups were computed based on the mean of the total CHIPS score. Optimal sensitivity and specificity of the total CHIPS score in detecting cognitive impairment were determined using a receiver operator characteristic curve.Results: Despite a similar demographic profile, subjects with a “High” lesion score performed significantly worse than the “Low” lesion score group on verbal (P=.007) and visuospatial (P=.02) memory, and on a global index of cognitive functioning (P=.001). Optimal sensitivity (82%) and specificity (83%) were reached with a threshold total CHIPS score of 18 points. Total CHIPS score and total hyperintense lesion load were correlated (σ=0.82, P<.0001).Conclusion: CHIPS is helpful in clinically predicting cognitive impairment in MS.

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Structural and Functional MRI Techniques in Multiple Sclerosis Related Cognitive Dysfunction

Folia Medica ◽

10.2478/folmed-2018-0031 ◽

2018 ◽

Vol 60 (4) ◽

pp. 505-511 ◽

Cited By ~ 1

Author(s):

Dessislava Iancheva ◽

Anastasiya Trenova ◽

Stefka Mantarova ◽

Kiril Terziyski

Keyword(s):

Multiple Sclerosis ◽

Magnetic Resonance ◽

Functional Mri ◽

Cognitive Dysfunction ◽

Gray Matter ◽

Social Impact ◽

Clinical Manifestations ◽

Cortical Reorganization ◽

Cortical Activation ◽

Brain Morphology

Abstract Multiple sclerosis (MS) is an inflammatory demyelinating and neurodegenerative disease of the central nervous system that is prevalent in young adults and therefore with significant social impact. Cognitive impairment occurs in 40% to 70% of patients with MS and has a weak correlation with disease duration. Neuropsycho-logical assessment is a standard method in the detection of cognitive dysfunction. However, in order to understand the etiology and evolution of cognitive dysfunction, several elaborate magnetic resonance techniques have been developed. Their aim is to measure structural changes in the CNS that are considered main substrates in cognitive function such as whole brain and gray matter atrophy, cortical lesions and changes in subcortical gray matter. Evidence shows that the clinical manifestations of multiple sclerosis are complex interactions between tissue damage, tissue repair and cortical reorganization. In order to study this heterogeneity, structural magnetic resonance analysis of brain morphology and functional magnetic resonance imaging are essential. This review summarizes current techniques in structural MRI and the value of functional MRI in understanding the link between cognitive deficit and cortical activation and reorganization.

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Oral Cladribine is Effective in the Treatment of Tumefactive Demyelination in Relapsing Remitting Multiple Sclerosis – A Case Report

The Open Neurology Journal ◽

10.2174/1874205x02014010109 ◽

2020 ◽

Vol 14 (1) ◽

pp. 109-114

Author(s):

Jihad Said Inshasi ◽

Pournamy Sarathchandran ◽

Mona Chetan Thakre ◽

Nouf Saeed Al Talai ◽

Reem Al Suwaidi ◽

...

Keyword(s):

Multiple Sclerosis ◽

Case Report ◽

Magnetic Resonance ◽

Immune Reconstitution ◽

Acute Onset ◽

Oligoclonal Bands ◽

Resonance Spectroscopy ◽

Sensory Level ◽

Limb Weakness ◽

The Brain

This case report describes a 32-year old Emirati patient with tumefactive multiple sclerosis (TMS) treated with a short course of cladribine tablets. The patient presented initially with acute onset of progressive gait unsteadiness, lower limb weakness, associated with numbness of four days duration. Neurological examination of right arms and both legs weakness with sensory level at T10. Contrast-enhanced magnetic resonance imaging (MRI) of the brain showed a large tumefactive demyelination with multiple demyelinating lesions in the brain, consistent with a diagnosis of multiple sclerosis. MRI of the spine cervical and dorsal revealed multiple enhancing lesions as well. Cerebrospinal fluid oligoclonal bands were positive, and IgG index was high. Magnetic resonance spectroscopy showed elevation of lactate on short echo time (TE) and elevation of choline on long TE. The patient was treated with pulse steroid followed by oral cladribine as immune reconstitution therapy in the acute phase. The patient showed significant improvement clinically and radiologically to the treatment. The patient was followed up for 2 years and showed excellent resolution of the tumefactive lesion with no new lesions. Immune reconstitution therapy can be an option for treatment of tumefactive demyelination in multiple sclerosis in the acute setting. To our knowledge, there are no reports of the use of immune reconstitution therapies for the treatment of tumefactive lesions in multiple sclerosis.

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Cerebral metabolism, magnetic resonance spectroscopy and cognitive dysfunction in early multiple sclerosis: an exploratory study

Neurological Research ◽

10.1179/1743132811y.0000000059 ◽

2012 ◽

Vol 34 (1) ◽

pp. 52-58 ◽

Cited By ~ 10

Author(s):

Morten Blinkenberg ◽

Henrik K Mathiesen ◽

Thomas Tscherning ◽

Agnete Jønsson ◽

Claus Svarer ◽

...

Keyword(s):

Multiple Sclerosis ◽

Magnetic Resonance ◽

Magnetic Resonance Spectroscopy ◽

Cognitive Dysfunction ◽

Exploratory Study ◽

Cerebral Metabolism ◽

Resonance Spectroscopy

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Dementia in multiple sclerosis: report of a case with cortical grey matter involvement and frontal-type-like clinical features

European Psychiatry ◽

10.1016/s0924-9338(11)72192-7 ◽

2011 ◽

Vol 26 (S2) ◽

pp. 485-485

Author(s):

R. Correia ◽

D. Dias ◽

A.J. Bastos-Leite ◽

E. Rio ◽

R. Curral

Keyword(s):

Multiple Sclerosis ◽

Case Report ◽

White Matter ◽

Frontal Lobe ◽

Cognitive Dysfunction ◽

Clinical Features ◽

Grey Matter ◽

Psychiatric Symptoms ◽

Eating Behaviour ◽

Cortical Grey Matter

Background/introductionAlthough multiple sclerosis (MS), a demyelinating disease of unknown aetiology, is primarily a white matter disease, it may also involve the grey matter, a feature not often demonstrated in vivo by means of magnetic resonance imaging (MRI). The involvement of cortical grey matter in MS may account for cognitive dysfunction and behavioural abnormalities.ObjectiveThe purpose of this report is to present the case of a patient with MS and clinical features mimicking dementia of the frontal type due to clear-cut cortical grey matter involvement in the left frontal lobe.Case reportA 55-year-old woman with relapsing remitting MS developed a clinical picture characterized by frontal deficits (e.g. attention, verbal fluency, and speed processing), disinhibition, loss of insight, perseveration, abnormal eating behaviour, agitation, insomnia, and depersonalization phenomena. Neuropsychological evaluation also revealed abnormal performance on the Trail Making and the Stroop tests. Besides typical demyelinating lesions and “black holes”, MRI showed a striking pattern of left frontal opercular involvement including cortical thinning, focal knife-edge appearance of the gyri, and marked gliosis in the adjacent white matter.DiscussionCognitive deficits in MS are typically subcortical, due to the expected predominance of white matter lesions. Nonetheless, the involvement of grey matter structures may contribute to a different pattern of cognitive dysfunction. For example, hippocampal involvement has been linked to memory impairment. This particular case report additionally illustrates how cortical grey matter involvement in the frontal lobe may lead (not unexpectedly) to a clinical condition mostly characterised by frontal deficits and psychiatric symptoms.

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