Brain and spinal cord abnormalities in multiple sclerosis. Correlation between MRI parameters, clinical subtypes and symptoms

Background: Understanding long-term disability in multiple sclerosis (MS) is a key goal of research; it is relevant to how we monitor and treat the disease. Objectives: The Magnetic Imaging in MS (MAGNIMS) collaborative group sought to determine the relationship of brain lesion load, and brain and spinal cord atrophy, with physical disability in patients with long-established MS. Methods: Patients had a magnetic resonance imaging (MRI) scan of their brain and spinal cord, from which we determined brain grey (GMF) and white matter (WMF) fractional volumes, upper cervical spinal cord cross-sectional area (UCCA) and brain T2-lesion volume (T2LV). We assessed patient disability using the Expanded Disability Status Scale (EDSS). We analysed associations between EDSS and MRI measures, using two regression models (dividing cohort by EDSS into two and four sub-groups). Results: In the binary model, UCCA ( p < 0.01) and T2LV ( p = 0.02) were independently associated with the requirement of a walking aid. In the four-category model UCCA ( p < 0.01), T2LV ( p = 0.02) and GMF ( p = 0.04) were independently associated with disability. Conclusions: Long-term physical disability was independently linked with atrophy of the spinal cord and brain T2 lesion load, and less consistently, with brain grey matter atrophy. Combinations of spinal cord and brain MRI measures may be required to capture clinically-relevant information in people with MS of long disease duration.

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A Case of Acute Encephalopathy Due to Autoimmune Overload

Journal of Clinical Review & Case Reports ◽

10.33140/jcrc.05.06.07 ◽

2020 ◽

Vol 5 (6) ◽

Keyword(s):

Multiple Sclerosis ◽

Spinal Cord ◽

Pediatric Population ◽

Autoimmune Disorder ◽

Acute Disseminated Encephalomyelitis ◽

Acute Encephalopathy ◽

Demyelinating Disorder ◽

Demyelinating Disorders ◽

Brain And Spinal Cord ◽

The Brain

Acute disseminated encephalomyelitis, also known as postinfectious encephalomyelitis, is considered an autoimmune disorder that causes inflammation of the brain and spinal cord. It was seen mainly in pediatric population possibly due to vaccination but there have been cases identified in adult [1-9]. Acute disseminated encephalomyelitis can be challenging to diagnose owing to fact that there have been many overlapping symptoms among other demyelinating disorder such multiple sclerosis and Neuromyelitis Optica. In this case report, we will discuss a case about a patient that presented due to acute encephalopathy and was noted to have an atypical MRI of the brain that was not consistent with results of the lumbar puncture [10-12]. Knowledge gained from this case will help bring awareness to the diagnose of acute disseminated encephalomyelitis and how imaging in context with the clinical picture can help us differentiate between the various demyelinating disorders; thereby, giving a better understanding of managing these patients as management can affect prognosis and outcomes.

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Brain and Spinal Cord MR Imaging Features in Multiple Sclerosis and Variants

Neuroimaging Clinics of North America ◽

10.1016/j.nic.2016.12.002 ◽

2017 ◽

Vol 27 (2) ◽

pp. 205-227 ◽

Cited By ~ 11

Author(s):

Iris Dekker ◽

Mike P. Wattjes

Keyword(s):

Multiple Sclerosis ◽

Spinal Cord ◽

Mr Imaging ◽

Imaging Features ◽

Brain And Spinal Cord

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Multiple Sclerosis in the Emirati Population: Onset Disease Characterization by MR Imaging

Multiple Sclerosis International ◽

10.1155/2019/7460213 ◽

2019 ◽

Vol 2019 ◽

pp. 1-6

Author(s):

Manzoor Ahmed ◽

Ruqqiya Mir ◽

Mustafa Shakra ◽

Safana Al Fardan

Keyword(s):

Multiple Sclerosis ◽

Spinal Cord ◽

Age Of Onset ◽

Female Dominance ◽

Cervical Cord ◽

Gulf Region ◽

Lesion Load ◽

Disseminated Disease ◽

Brain And Spinal Cord ◽

The Brain

Background and Objectives. Multiple Sclerosis (MS) epidemiology is on the path of globalization mainly due to changing environmental factors. The prevalence of MS is on the rise in the Middle East and Persian Gulf region. Our observations has led us to hypothesize a heavy MRI lesion load at the onset of disease in a relatively younger native population. We aimed to estimate and characterize the onset disease on MRI using McDonald’s criteria while applying its terms of “Dissemination in Space (DIS) and Dissemination in Time (DIT)”. Materials and Methods. Retrospective review of onset MRI studies of 181 Emirati (native) individuals. Basic demographics were captured. Only 47 patients with Clinically Definite MS (CDMS) were included who had onset diagnostic MRI available. Lesion load was quantified using the specific zones of involvement designated for DIS: (1) Periventricular (PVZ) (I), (2) Juxta-cortical (II) (3) Infra-tentorial (III) and, (4) Spinal cord (IV). PVZ was sub-classified and lesions were quantified. A single enhancing lesion was required for DIT. Results. Average age of onset was about 26 years with female dominance of about 2 : 1. About 50% had all 4 zones and about 85% had at least 3 zones involved at the onset. Involvement of only 1 zone was rare. Dissemination in time (DIT) in brain and/or cord was present in approximately 50%. Each of the 4 zones were involved in at least 70% of cases. PVZ was not spared in any case with at least 3 lesions present in approx. 95% and ≥12 lesions in approx. half of the patients. Spinal cord specifically cervical cord was involved in up to 80% with typical patchy lesions. Conclusion. Onset disease characterization using MRI in a young Emirati cohort showed a heavy lesion load in the brain and spinal cord at the onset, signifying cumulative disease before presentation. Disseminated disease also facilitated early diagnosis of MS. The findings have significant potential ramifications for local environmental and cultural factors, as well as disease course and disability progression.

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