Diffuse Pain and Abnormal Brain MRI Findings

2021 ◽  
pp. 26-28
Author(s):  
Andrew McKeon
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Central Sensitization ◽  
Demyelinating Disease ◽  
Brain Magnetic Resonance Imaging ◽  
Chronic Fatigue ◽  
Cognitive Symptoms ◽  
Resonance Imaging ◽  
Poor Tolerance ◽  
Body Discomfort

A 46-year-old woman with a remote history of classical migraine had development of pain behind her left eye followed by holocephalic headache. She subsequently began to have episodic headaches. Her sleep became disrupted. Irritability, cognitive symptoms, and fatigue then developed. Her headaches occurred daily, along with whole-body discomfort. She underwent polysomnography and was diagnosed with obstructive sleep apnea syndrome. Her sleep quality improved with continuous positive airway pressure therapy, but her daily headaches, cognitive symptoms, and limb pain persisted. She was diagnosed with “seronegative Lyme disease.” Fourteen days of doxycycline therapy was not accompanied by improvement in symptoms. After extensive laboratory evaluations and consultations, the patient was diagnosed with fibromyalgia. Short trials of low doses of amitriptyline, nortriptyline, gabapentin, and pregabalin were undertaken, but these were poorly tolerated and discontinued in each instance. The patient was concerned that she may have multiple sclerosis, and she underwent magnetic resonance imaging of the brain. The radiology report documented multiple, small areas of T2-signal change, and demyelinating disease was included in the radiologic differential diagnosis. The patient then sought a second opinion. Evaluations at Mayo Clinic supported evidence of diffuse myofascial limb and back pain and tenderness. Brain magnetic resonance images were reviewed. Extensive work-up for alternative differential diagnostic considerations for her pain was unremarkable. The patient was diagnosed with fibromyalgia with features of central sensitization, with brain magnetic resonance imaging demonstrating nonspecific radiologic abnormalities. A detailed discussion about fibromyalgia and central sensitization was undertaken with the patient. The concepts rehabilitative approaches were reviewed. Slowly progressive, incremental, physical reconditioning, and cognitive behavioral retraining were recommended. She was advised to complete a fibromyalgia and chronic fatigue treatment program, focusing on cognitive and behavioral approaches, stress management, sleep hygiene, balanced lifestyle, moderation, energy conservation, and graded exercise. No new medications were recommended given her previous poor tolerance. The patient’s atypical symptoms, normal examination findings, and brain magnetic resonance imaging appearance assisted in excluding a diagnosis of demyelinating disease. The radiologic findings, termed white matter leukoaraiotic change, are commonly encountered in healthy persons as they age, particularly in patients with migraine or those with microvascular risk factors.

Fluctuating Vision Loss, Seizures, and Left Parieto-Occipital Mass

2021 ◽  
pp. 22-25
Author(s):  
Alicja Kalinowska-Lyszczarz ◽  
W. Oliver Tobin ◽  
Yong Guo ◽  
Claudia F. Lucchinetti
Keyword(s):  
Magnetic Resonance Imaging ◽  
Cerebrospinal Fluid ◽  
Magnetic Resonance ◽  
Demyelinating Disease ◽  
Disease Onset ◽  
Brain Magnetic Resonance Imaging ◽  
Resonance Imaging ◽  
Intravenous Methylprednisolone ◽  
Fluid Analysis ◽  
Demyelinating Lesions

A 35-year-old man sought care for progressive visual disturbance. Magnetic resonance imaging of the brain showed a large, left-sided, parieto-occipital, contrast-enhancing lesion. He was treated with dexamethasone with brief improvement in vision. Within 5 days he had progressive vision worsening. Two weeks after the onset of his symptoms, brain magnetic resonance imaging showed a decrease in lesion size, and corticosteroids were discontinued. Two months after symptom onset he was found to have alexia without agraphia, and follow-up magnetic resonance imaging showed an increased size of the lesion. Two months after disease onset, the patient underwent a left occipital brain biopsy, which demonstrated a macrophage-enriched active demyelinating lesion with relative axonal sparing. Right arm weakness and aphasia developed, along with a fever. He was treated with dexamethasone. Electroencephalography indicated multiple seizures. Repeated cerebrospinal fluid analysis showed a slightly increased white blood cell count, increased protein level, immunoglobulin G index of 0.84, and the presence of 3 cerebrospinal fluid-unique oligoclonal bands. He was treated with 5 days of intravenous methylprednisolone and levetiracetam, with improvement. Three and a half years later, the patient came to the emergency department with weakness of the left leg associated with reduced sensation. Spinal magnetic resonance imaging showed a new demyelinating contrast-enhancing lesion from T2 to T7. He was treated with 5 days of intravenous methylprednisolone followed by 6 sessions of plasma exchange, with improvement. A diagnosis of relapsing tumefactive demyelination was made. The patient was subsequently treated with ocrelizumab. Tumefactive demyelinating lesions pose a diagnostic challenge, especially if they are the first manifestations of demyelinating disease. Typically, tumefactive demyelinating lesions are large (>2 cm) and are associated with edema, mass effect, and variable patterns of contrast enhancement.

scholarly journals Reversible MR Findings in Marchiafava-Bignami Disease

2019 ◽  
Vol 2019 ◽  
pp. 1-3 ◽  
Author(s):  
Carmine Franco Muccio ◽  
Luca De Lipsis ◽  
Rossella Belmonte ◽  
Alfonso Cerase
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Death Rate ◽  
Demyelinating Disease ◽  
Brain Mri ◽  
Disease Process ◽  
Brain Magnetic Resonance Imaging ◽  
Type B ◽  
Resonance Imaging ◽  
Magnetic Resonance Imaging Mri

Marchiafava-Bignami Disease (MBD) is a toxic demyelinating disease often diagnosed in chronic alcoholics. The disease process typically involves the corpus callosum and clinically presents with various manifestations resulting in MBD type A and type B on the basis of clinical condition, extent of callosal involvement and extracallosal involvement at brain magnetic resonance imaging (MRI), and prognosis. The death rate is high. We report a patient affected by MBD type B, who presented an isolated reversible splenial lesion at brain MRI and achieved a favorable recovery.

Prevalence of brain magnetic resonance imaging meeting Barkhof and McDonald criteria for dissemination in space among headache patients

2013 ◽  
Vol 19 (8) ◽  
pp. 1101-1105 ◽  
Author(s):  
Syrone Liu ◽  
Jonathan Kullnat ◽  
Dennis Bourdette ◽  
Jack Simon ◽  
Dale F Kraemer ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Demyelinating Disease ◽  
Brain Mri ◽  
Brain Magnetic Resonance Imaging ◽  
Resonance Imaging ◽  
Post Contrast ◽  
Mcdonald Criteria ◽  
Magnetic Resonance Imaging Mri ◽  
Headache Patients

Background: Incidental T2 white matter hyperintensities (WMHs) in headache patients on brain magnetic resonance imaging (MRI) may prompt concern for demyelinating disease. Objective: We reviewed brain MRI studies in patients with headaches without known demyelinating disease to determine the prevalence meeting imaging criteria for multiple sclerosis (MS) using two different definitions of “juxtacortical” and “periventricular”. Methods: Consecutive patients undergoing pre- and post-contrast MRI for headaches over a 25-month period were retrospectively identified. Exclusions included patients under age 10 and over 55 years or with known demyelinating disorder. Patients were classified as meeting: 1) Barkhof and 2) 2010 McDonald dissemination in space criteria for MS based on: FLAIR/T2 scans for WMH and enhanced T1-weighted images for enhancement. Both groups were further differentiated by defining “periventricular” and “juxtacortical” as WMH contacting ventricle and cortex (Barkhof “touching”, McDonald “touching”) versus WMH within 3 mm (Barkhof – 3 mm, McDonald – 3 mm). Results: 326/564 (58%) studies met inclusion criteria. WMH prevalence was 168/326 (51.53%). Barkhof “touching” criteria were met in 4/168 (2.4%) and in 12/168 (7.1%) of the 3 mm group. McDonald criteria were met in 41/168 (24.4%) for “touching” and 58/168 (34.5%) for 3 mm, respectively. Conclusion: Barkhof and McDonald criteria were met in 2.4–7.1% and 24.4–34.5%, respectively.

Сauses of Dizziness in Patients with Suspected Stroke

2018 ◽  
Vol 7 (3) ◽  
pp. 217-221
Author(s):  
E. V. Shevchenko ◽  
G. R. Ramazanov ◽  
S. S. Petrikov
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Demyelinating Disease ◽  
Heart Rhythm ◽  
Diagnostic Methods ◽  
Deficiency Anemia ◽  
Resonance Imaging ◽  
Peripheral Vestibulopathy ◽  
Suspected Stroke ◽  
The Brain

Background Acute dizziness may be the only symptom of stroke. Prevalence of this disease among patients with isolated dizziness differs significantly and depends on study design, inclusion criteria and diagnostic methods. In available investigations, we did not find any prospective studies where magnetic resonance imaging, positional maneuvers, and Halmagyi-Curthoys test had been used to clarify a pattern of diseases with isolated acute dizziness and suspected stroke.Aim of study To clarify the pattern of the causes of dizziness in patients with suspected acute stroke.Material and methods We examined 160 patients admitted to N.V. Sklifosovsky Research Institute for Emergency Medicine with suspected stroke and single or underlying complaint of dizziness. All patients were examined with assessment of neurological status, Dix-Hollpike and Pagnini-McClure maneuvers, HalmagyiCurthoys test, triplex scans of brachiocephalic arteries, transthoracic echocardiography, computed tomography (CT) and magnetic resonance imaging (MRI) of the brain with magnetic field strength 1.5 T. MRI of the brain was performed in patients without evidence of stroke by CT and in patients with stroke of undetermined etiology according to the TOAST classification.Results In 16 patients (10%), the cause of dizziness was a disease of the brain: ischemic stroke (n=14 (88%)), hemorrhage (n=1 (6%)), transient ischemic attack (TIA) of posterior circulation (n=1 (6%)). In 70.6% patients (n=113), the dizziness was associated with peripheral vestibulopathy: benign paroxysmal positional vertigo (n=85 (75%)), vestibular neuritis (n=19 (17%)), Meniere’s disease (n=7 (6%)), labyrinthitis (n=2 (1,3%)). In 6.9% patients (n=11), the cause of dizziness was hypertensive encephalopathy, 1.9% of patients (n=3) had heart rhythm disturbance, 9.4% of patients (n=15) had psychogenic dizziness, 0.6% of patients (n=1) had demyelinating disease, and 0.6% of patients (n=1) had hemic hypoxia associated with iron deficiency anemia.Conclusion In 70.6% patients with acute dizziness, admitted to hospital with a suspected stroke, peripheral vestibulopathy was revealed. Only 10% of patients had a stroke as a cause of dizziness.

scholarly journals Balo’s Concentric Sclerosis Mimicking Tumor on Magnetic Resonance Imaging in a Young Patient

2021 ◽  
Vol 14 ◽  
pp. 117954762198967
Author(s):  
Van Trung Hoang ◽  
Cong Thao Trinh ◽  
Hoang Anh Thi Van ◽  
Thanh Tam Thi Nguyen ◽  
Vichit Chansomphou ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Demyelinating Disease ◽  
Management Strategies ◽  
Resonance Imaging ◽  
Mri Findings ◽  
Demyelinating Lesions ◽  
Baló’S Concentric Sclerosis ◽  
Magnetic Resonance Imaging Mri ◽  
Subcortical Regions

Balo’s concentric sclerosis (BCS) is a rare demyelinating disease known as Multiple Sclerosis (MS) lesion type III. It is a disease of the white matter of the brain characterized by a round lesion with variable concentric myelinated and demyelinated layers, appearing as “onion bulb.” We present a case of BCS and discuss the imaging findings and management strategies of this disease. A 26-y-old male developed headache, weakness, and numbness of limbs. Magnetic resonance imaging (MRI) showed concentric lamellar like demyelinating lesions at the subcortical regions. The patient’s neurological symptoms were consistent with the MRI findings.

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