P4136Neurogenic stunned myoacardium in multiple sclerosis patients

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
E Gialafos ◽  
E Tsougos ◽  
E Andreadou ◽  
D Tzanetakos ◽  
I Tzartos ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Wide Spectrum ◽  
Coronary Artery Spasm ◽  
Stunned Myocardium ◽  
Common Finding ◽  
Demyelinating Lesions ◽  
Neurogenic Stunned Myocardium ◽  
Thoracic Part ◽  
Multiple Sclerosis Patients ◽  
Upper Thoracic

Abstract A wide spectrum of topics regarding Multiple Sclerosis (MS) have been thoroughly studied, like immunology, nature of demyelinating lesions (DL's), therapeutics, etc. However, little is known about the influence of MS DL's on the cardiovascular system and especially in the coronary vasculature although few reports mention coronary vasospasm due to autonomic nervous system (ANS) abnormalities. Aim of this study was the detection the presence of Neurogenic Stunned Myocardium (NSM) through perfusion test. Method We enrolled 50 asymptomatic fulfilling the criteria MS patients, aged 45±7 years old and disease in our study duration of 6±13 years with EDSS= 2,5. After echocardiography and clinical examination as primary screening, pharmacologic stress thallium 201 scintigraphy and/or coronary angiography were performed to identify the incidence of NSM. Clinical characteristics of MS, type of disease, treatments as well as localization of demyelinating plaques (DP) were noted. Results 13 patients (26%) had abnormal scintigraphy test although clinical profile was not indicative. Cardiac ultrasound showed that 2 patients from this group had a critical ejection fraction (around 50%). All positive patients that underwent for coronary angiogram were negative implying coronary artery spasm as a potential mechanism for the stress positive result. A common finding of all positive patients was the localization of DP which was in the lateral horn of the lower cervical part (C5–7) and upper thoracic part (Th1–4). No correlation seems to have the presence of CAD with disease duration, EDSS and treatment approaches. Discussion Our study shows a high incidence of NSM. This finding due to the location of the DP seems to correlate with ANS disturbance and might help to distinguish patients at higher risk.

scholarly journals Intermittent Atrioventricular Block following Fingolimod Initiation

2014 ◽  
Vol 2014 ◽  
pp. 1-4 ◽  
Author(s):  
E. Gialafos ◽  
S. Gerakoulis ◽  
A. Grigoriou ◽  
V. Haina ◽  
C. Kilidireas ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Spinal Cord ◽  
Atrioventricular Block ◽  
Frequency Domain Analysis ◽  
Thoracic Spinal Cord ◽  
Sympathetic Function ◽  
Thoracic Spinal ◽  
Demyelinating Lesions ◽  
Cardiac Sympathetic Function ◽  
Upper Thoracic

A 47-year-old female patient with multiple sclerosis (MS) developed symptomatic intermittent 2nd degree atrioventricular block (AVB) of five-hour duration, five hours after the first two doses of fingolimod, that resolved completely. Frequency domain analysis of heart rate variability (HRV) revealed increased parasympathetic activity and decreased sympathetic tone, while modified Ewing tests were suggestive of impaired cardiac sympathetic function. We hypothesize that expression of this particular arrhythmia might be related to autonomic nervous system (ANS) dysfunction due to demyelinating lesions in the upper thoracic spinal cord, possibly augmented by the parasympathetic effect of the drug.

The spectrum of acute cardiopulmonary events associated with multiple sclerosis exacerbations

2019 ◽  
Vol 25 (6) ◽  
pp. 758-765 ◽  
Author(s):  
Cristina Valencia-Sanchez ◽  
Brent P Goodman ◽  
Jonathan L Carter ◽  
Dean M Wingerchuk
Keyword(s):  
Multiple Sclerosis ◽  
Nervous System ◽  
Cardiac Function ◽  
Pulmonary Edema ◽  
Myocardial Dysfunction ◽  
Case Reports ◽  
Systemic Blood Pressure ◽  
Stunned Myocardium ◽  
Neurogenic Pulmonary Edema ◽  
Demyelinating Lesions

Diverse acute neurological injuries may cause acute cardiopulmonary events including neurogenic pulmonary edema (NPE) and neurogenic stunned myocardium (NSM). The mechanism is probably mediated by sympathetic nervous system activation. Focal central nervous system (CNS) lesions, such as demyelinating lesions in multiple sclerosis (MS), may also cause cardiopulmonary disturbances. We aim to review the acute cardiopulmonary events associated with MS relapses. We performed a literature search using PubMed, and selected case reports of acute cardiac and/or pulmonary events related to MS exacerbations. We grouped these events into three categories: 1) NPE with normal cardiac function; 2) NSM and Takotsubo cardiomyopathy (TTC); 3) coexisting myocardial dysfunction and pulmonary edema. In some cases, cardiac and pulmonary symptoms preceded the onset of neurological symptoms. The majority of cases were associated with acute demyelinating lesions located in the medulla. Acute brainstem MS relapses, with demyelinating lesions affecting the medulla, may cause acute cardiac and pulmonary events presumably secondary to sympathetic hyperstimulation. Specific regions in the medulla that regulate cardiac function, systemic blood pressure and pulmonary hydrostatic pressure seem to be responsible for these events.

scholarly journals Can T2 blackout effect be a marker of iron accumulation in brains of multiple sclerosis patients?

2020 ◽  
Vol 93 (1113) ◽  
pp. 20200552
Author(s):  
Mehmet Fatih Erbay ◽  
Özden Kamışlı ◽  
Nur Betül Karatoprak
Keyword(s):  
Multiple Sclerosis ◽  
Imaging Finding ◽  
Treatment Strategies ◽  
Daily Practice ◽  
Iron Accumulation ◽  
Cortical Atrophy ◽  
Common Finding ◽  
Apparent Diffusion ◽  
And Gender ◽  
Multiple Sclerosis Patients

Objective : T2 blackout (TBO) effect, which is a common finding in the brains of multiple sclerosis (MS) patients and older population that are imaged for other reasons on diffusion weighted imagings (DWI) and apparent diffusion coefficient (ADC) map show the existence of paramagnetic materials in the tissue. Because iron is known to accumulate in especially deep gray matter (DGM) structures in MS brains, we aimed to investigate the relationship between TBO and clinico-radiological parameters that may be iron-related in MS. Methods: We retrospectively reviewed the latest MR images of MS patients on 3 Tesla MR scanner between 2018 and 2019. TBO existence and severity on DWI–ADC was assessed by two radiologists and its correlation with several outcomes of MS was investigated. Results: No significant relationship was found between TBO and gender, subtype of MS whereas TBO was positively correlated with parameters such as black-hole lesions, cortical atrophy, duration of disease, age and extended disability status scale (EDSS) score. Conclusions: TBO shows correlation with the conditions which were revealed to be associated with iron accumulation in the brain of MS patients in the literature. Therefore, we concluded that TBO and its severity in DGM may represent iron accumulation in MS brains. Advances in knowledge: TBO effect as a frequent imaging finding in daily practice may be used as predictor of the disease course of MS due to possible effects of iron accumulation in brain and thereby may be useful in modifying treatment strategies.

Half-dose fingolimod for treating relapsing-remitting multiple sclerosis: Observational study

2017 ◽  
Vol 24 (2) ◽  
pp. 167-174 ◽  
Author(s):  
Chiara Zecca ◽  
Arianna Merlini ◽  
Giulio Disanto ◽  
Mariaemma Rodegher ◽  
Letizia Panicari ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Observational Study ◽  
Clinical Laboratory ◽  
Significant Proportion ◽  
Lower Baseline ◽  
Neuroimaging Data ◽  
Demyelinating Lesions ◽  
Magnetic Resonance Imaging Mri ◽  
Multiple Sclerosis Patients ◽  
Relapsing Remitting Multiple Sclerosis

Objectives: To investigate the efficacy and safety of fingolimod (FTY) 0.5 mg administered every other day (FTY-EOD) compared to every day (FTY-ED) in multiple sclerosis patients. Methods: Multicentre retrospective observational study. Clinical, laboratory and neuroimaging data were consecutively collected from 60 FTY-EOD and 63 FTY-ED patients. Baseline characteristics were compared using logistic regression. Efficacy in preventing occurrence of relapses and demyelinating lesions was tested using propensity score–adjusted Cox and linear regressions. Results: Weight was inversely associated with risk of switch to FTY-EOD because of any reason (odds ratio (OR) = 0.94, 95% confidence interval (95% CI) = 0.89–0.99, p = 0.026), and female sex and lower baseline lymphocyte count were positively associated with switch because of lymphopenia. Compared to FTY-ED patients, FTY-EOD patients were at higher risk of developing relapses (hazard ratio (HR) = 2.98, 95% CI = 1.07–8.27, p  = 0.036) and either relapses or new magnetic resonance imaging (MRI) demyelinating lesions (combined outcome, HR = 2.07, 95% CI = 1.06–4.08, p  = 0.034). Within FTY-EOD, treatment with natalizumab before FTY and lower age were positively associated with risk of developing relapses and combined outcome, respectively (HR = 25.71, 95% CI = 3.03–217.57, p = 0.002 and HR = 0.85, 95% CI = 0.77–0.96, p  = 0.005). FTY-EOD was overall well tolerated. Conclusion: Disease reactivation was observed in a significant proportion of patients treated with FTY-EOD. Neurologists should be cautious when reducing FTY administration to every other day, especially in younger patients and those previously treated with natalizumab.

Tako-tsubo cardiomyopathy in aneurysmal subarachnoid hemorrhage: an underappreciated ventricular dysfunction

2006 ◽  
Vol 105 (2) ◽  
pp. 264-270 ◽  
Author(s):  
Vivien H. Lee ◽  
Heidi M. Connolly ◽  
Jimmy R. Fulgham ◽  
Edward M. Manno ◽  
Robert D. Brown ◽  
...  
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Cerebral Vasospasm ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Wide Spectrum ◽  
Left Ventricular ◽  
Stunned Myocardium ◽  
Neurological Intensive Care Unit ◽  
Poor Grade ◽  
Neurogenic Stunned Myocardium ◽  
Tako Tsubo Cardiomyopathy

Object Neurogenic stunned myocardium in aneurysmal subarachnoid hemorrhage (SAH) is associated with a wide spectrum of reversible left ventricular wall motion abnormalities and includes a subset of patients with a pattern of apical akinesia and concomitant sparing of basal segments called “tako-tsubo cardiomyopathy.” Methods After obtaining institutional review board approval, the authors retrospectively identified among all patients admitted to the Mayo Clinic’s Neurological Intensive Care Unit between January 1990 and January 2005 those with aneurysmal SAH who had met the echocardiographic criteria for tako-tsubo cardiomyopathy. Among 24 patients with SAH-induced reversible cardiac dysfunction, the authors identified eight with SAH-induced tako-tsubo cardiomyopathy. All eight patients were women with a mean age of 55.5 years (range 38.6–71.1). Seven patients presented with a poor-grade SAH, reflected by a Hunt and Hess grade of III or IV. Four patients underwent aneurysm clip application, and four underwent endovascular coil occlusion. The initial mean ejection fraction (EF) was 38% (range 25–55%), and the mean EF at recovery was 55% (range 40–68%). Cerebral vasospasm developed in six patients, but cerebral infarction developed in only three patients. Conclusions The authors describe the largest cohort with aneurysmal SAH–induced tako-tsubo cardiomyopathy. In the SAH population, tako-tsubo cardiomyopathy predominates in postmenopausal women and is often associated with pulmonary edema, prolonged intubation, and cerebral vasospasm. Additional studies are warranted to understand the complex mechanism involved in tako-tsubo cardiomyopathy and its intriguing relationship to neurogenic stunned myocardium.

Clinical and Radiologic Features, Pathology, and Treatment of Baló Concentric Sclerosis

Neurology ◽  
2021 ◽  
pp. 10.1212/WNL.0000000000012230
Author(s):  
Evan A. Jolliffe ◽  
Yong Guo ◽  
Todd A Hardy ◽  
P. Pearse Morris ◽  
Eoin P. Flanagan ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Clinical Course ◽  
Tertiary Care ◽  
Demyelinating Diseases ◽  
Demyelinating Lesions ◽  
Tertiary Care Centers ◽  
Multiple Sclerosis Patients ◽  
Serial Mri ◽  
Distinct Subtype

Objective:To describe clinical, radiological and pathological features of patients with Baló’s concentric sclerosis (BCS) and assess overlap between BCS and other central nervous system inflammatory demyelinating diseases.Methods:Retrospective review of BCS cases from US and Australian tertiary care centers.Results:We identified 40 BCS cases with 38 available MRIs. Solitary MRI lesions were present in 26% (10/38). We saw >1 active concurrent BCS lesion in 45% (17/38). A third (13/38) had multiple sclerosis-suggestive lesions on the index MRI, of which 10 fulfilled Barkhof criteria. In patients with serial MRI performed within one month of the index MRI, lesions expanded radially with sequentially increased numbers of T2 hyperintense rings 52% (14/27). Initially non-enhancing or centrally enhancing lesions subsequently developed single or multiple enhancing rings (41%; 9/22) and incomplete enhancing rings (14%; 3/22). Discordance between rings as they appear on ADC, DWI, and gadolinium-enhanced imaging was observed in 67% (22/33). AQP4-IgG (n=26) and MOG-IgG (n=21) were negative in all patients with serum available. Clinical response to steroid treatment was seen in 46% (13/28). A monophasic clinical course was present in 56% (18/32) at last follow-up (median 27.5 months; range 3-100 months). The initial attack was fatal in 10% (4/40). Median time from symptom onset to death was 23 days (range 19-49 days). All 17 patients with pathology available demonstrated typical findings of multiple sclerosis. Patients with active demyelinating lesions all demonstrated oligodendrocytopathy (pattern III).Conclusions:BCS may be a distinct subtype of multiple sclerosis characterized by pattern III immunopathology.

CENTRAL MOTOR PATHWAYS IN CHILDREN WITH MULTIPLE SCLEROSIS

2013 ◽  
Vol 68 (11) ◽  
pp. 34-37
Author(s):  
V. B. Voitenkov ◽  
V. N. Komantsev ◽  
N. V. Skripchenko ◽  
G. P. Ivanova ◽  
A. V. Surovtseva ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Transcranial Magnetic Stimulation ◽  
Motor Neurons ◽  
Magnetic Stimulation ◽  
Motor Evoked Potentials ◽  
High Sensitivity ◽  
Membrane Excitability ◽  
Motor Pathways ◽  
Demyelinating Lesions ◽  
Multiple Sclerosis Patients

Aim: to evaluate motor pathways involvement in children with multiple sclerosis. Patients and methods: we used transcranial magnetic stimulation method. 9 children with relapsing-remitting multiple sclerosis (mean duration 1,68 years) and 20 controls were enrolled. Results: in most of the cases findings in multiple sclerosis group were abnormal. More often polyphasic changes of the motor evoked potentials (MEP) shape (78% of the cases) and elevation of MEP threshold (88%) were seen. Conclusions: transcranial magnetic stimulation demonstrated high sensitivity in children with multiple sclerosis. Main neurophysiologic findings in multiple sclerosis in children may reflect altering membrane excitability of motor neurons and demyelinating lesions. Axonal damage in children with multiple sclerosis are less apparent. 

scholarly journals Gray Matter Pathology in MS: Neuroimaging and Clinical Correlations

2013 ◽  
Vol 2013 ◽  
pp. 1-16 ◽  
Author(s):  
Justin Morris Honce
Keyword(s):  
Multiple Sclerosis ◽  
Gray Matter ◽  
Cognitive Disability ◽  
Substantial Impact ◽  
Gray Matter Atrophy ◽  
Demyelinating Lesions ◽  
Disease Modifying ◽  
Autopsy Specimens ◽  
Multiple Sclerosis Patients

It is abundantly clear that there is extensive gray matter pathology occurring in multiple sclerosis. While attention to gray matter pathology was initially limited to studies of autopsy specimens and biopsies, the development of new MRI techniques has allowed assessment of gray matter pathologyin vivo. Current MRI techniques allow the direct visualization of gray matter demyelinating lesions, the quantification of diffuse damage to normal appearing gray matter, and the direct measurement of gray matter atrophy. Gray matter demyelination (both focal and diffuse) and gray matter atrophy are found in the very earliest stages of multiple sclerosis and are progressive over time. Accumulation of gray matter damage has substantial impact on the lives of multiple sclerosis patients; a growing body of the literature demonstrates correlations between gray matter pathology and various measures of both clinical disability and cognitive impairment. The effect of disease modifying therapies on the rate accumulation of gray matter pathology in MS has been investigated. This review focuses on the neuroimaging of gray matter pathology in MS, the effect of the accumulation of gray matter pathology on clinical and cognitive disability, and the effect of disease-modifying agents on various measures of gray matter damage.

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