Lesions Found by Chance

2021 ◽  
pp. 29-31
Author(s):  
Dean M. Wingerchuk
Keyword(s):  
Magnetic Resonance Imaging ◽  
Multiple Sclerosis ◽  
Magnetic Resonance ◽  
Episodic Migraine ◽  
Periventricular White Matter ◽  
Imaging Findings ◽  
Resonance Imaging ◽  
Migraine Headaches ◽  
Radiologically Isolated Syndrome ◽  
History Of

A healthy 26-year-old woman with a history of episodic migraine without aura since age 12 years had a first-ever event of transient visual impairment. She reported to her neurologist that she “lost vision” for 15 minutes and described a “black blob” with a bright jagged border that moved across her binocular visual field and resolved without sequelae. Minutes later, one of her typical migraine headaches developed. Given the patient’s history of typical episodic migraine, the new visual event’s clinical characteristics were highly consistent with a migraine aura. Because of the new transient visual symptoms, the neurologist ordered brain magnetic resonance imaging, which showed several periventricular white matter lesions, including some that involved the corpus callosum and were oriented perpendicular to the septocallosal surface. The patient was counseled about the magnetic resonance imaging findings and expressed the desire to fully evaluate her risk of multiple sclerosis. The patient was diagnosed with radiologically isolated syndrome. The patient was counseled regarding the relevance of the magnetic resonance imaging findings and risk of future development of multiple sclerosis. She was not prescribed a disease-modifying therapy for multiple sclerosis. This patient has radiologically isolated syndrome —incidentally found magnetic resonance imaging lesions consistent with demyelination in a patient with no symptoms or signs suggestive of multiple sclerosis.

Cognition with magnetic resonance imaging findings and social activities in patients with multiple sclerosis in a Japanese cohort

2018 ◽  
Vol 10 (1) ◽  
pp. 41-48
Author(s):  
Masaaki Niino ◽  
Toshiyuki Fukazawa ◽  
Jun‐ichi Kira ◽  
Tatsusada Okuno ◽  
Masahiro Mori ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Multiple Sclerosis ◽  
Magnetic Resonance ◽  
Social Activities ◽  
Imaging Findings ◽  
Resonance Imaging ◽  
Japanese Cohort

Progressive Gait Difficulties

2021 ◽  
pp. 62-64
Author(s):  
I. Vanessa Marin Collazo
Keyword(s):  
Magnetic Resonance Imaging ◽  
Multiple Sclerosis ◽  
Magnetic Resonance ◽  
Progressive Multiple Sclerosis ◽  
Primary Progressive Multiple Sclerosis ◽  
Resonance Imaging ◽  
Primary Progressive ◽  
Mcdonald Criteria ◽  
Mild Reduction ◽  
History Of

A 58-year-old, right-handed man with a medical history of nephrolithiasis, essential hypertension, and type 2 diabetes sought care for a 6-year history of gait impairment. Initially, he noted subtle left foot and ankle weakness with associated falls that progressed over time. Two to 3 years later he again noted progressive left leg weakness and new arm weakness. Subsequently, progressive pain developed on the soles of his feet in addition to edema with erythematous discoloration around the left ankle and foot. On neurologic examination, he was found to have mild upper motor neuron pattern weakness in the left arm and leg, most pronounced in the left hand finger extensor and left hip flexion and abduction. Left patellar reflex was brisk, and there was an extensor Babinski sign on the left. There was mild reduction in pinprick sensation in both feet. His gait was spastic with left leg circumduction. Magnetic resonance imaging of the brain showed left-sided predominant periventricular and subcortical T2 fluid-attenuated inversion recovery hyperintensities. Magnetic resonance imaging of the cervical and thoracic spinal cord showed intramedullary cord T2 signal hyperintensities, eccentrically located on the left at C3, C5, C6, on the right at C7 to T1, and centrally at T4/T5 and T8/T9. A diagnosis of primary progressive multiple sclerosis was made. The patient met the 2017 McDonald criteria for primary progressive multiple sclerosis. After the diagnosis was confirmed and comprehensive education about the disease and the role of disease-modifying therapy was discussed with the patient, he was started on ocrelizumab. Gabapentin was started for management of painful foot paresthesias. Vitamin D3 supplementation was started. Physical therapy was also initiated. Multiple sclerosis is a chronic immune-mediated demyelinating disease of the central nervous system and is the leading cause of disability in the young population. Approximately 1 million people in the United States currently have multiple sclerosis.

Progressive Spasticity With a Single Magnetic Resonance Imaging Lesion

2021 ◽  
pp. 20-21
Author(s):  
Samantha A. Banks ◽  
Eoin P. Flanagan
Keyword(s):  
Magnetic Resonance Imaging ◽  
Multiple Sclerosis ◽  
Magnetic Resonance ◽  
Oligoclonal Bands ◽  
Resonance Imaging ◽  
Fluid Analysis ◽  
Skin Cancers ◽  
Clinical Episode ◽  
History Of ◽  
The Right

A 59-year-old White man with a history of excised basal and squamous cell skin cancers was evaluated for gait difficulties. He had erectile dysfunction but no bowel or bladder dysfunction. He also reported fatigue. He began using a cane for ambulation 2 weeks before evaluation at our facility. His medications included vitamin D and sildenafil. He was a lifelong nonsmoker and had no family history of multiple sclerosis. Neurologic examination at the time of our evaluation 3 years after onset was notable for a positive Hoffman sign on the right and mild weakness of the right triceps but preserved strength elsewhere. He had a spastic gait with moderate spasticity in both lower extremities, hyperreflexic patellar and ankle jerks bilaterally, and bilateral positive Babinski sign. The remainder of the examination was essentially normal. Magnetic resonance imaging of the brain showed a single lesion at the cervicomedullary junction and medullary pyramids, more prominent on the right. There was also some accompanying atrophy that was also visible on cervical spine magnetic resonance imaging. Results of cerebrospinal fluid analysis showed a normal white blood cell count, increased protein concentration (108 mg/dL), and positive oligoclonal bands. The progressive nature of his symptoms, spinal fluid results, and lesion appearance were all consistent with a diagnosis of progressive solitary sclerosis. At the time this patient was seen, no immunomodulatory medications for progressive solitary sclerosis were approved, so no immunomodulatory medication was tried. Ongoing symptomatic management was recommended. Progressive solitary sclerosis is a rare variant of multiple sclerosis in which patients have a single central nervous system demyelinating lesion and development of motor progression attributable to that lesion. Patients can initially have a clinical episode followed by progression or can have a progressive course without an initial relapse.

THE CORRELATION OF URODYNAMIC FINDINGS WITH CRANIAL MAGNETIC RESONANCE IMAGING FINDINGS IN MULTIPLE SCLEROSIS

1998 ◽  
Vol 159 (3) ◽  
pp. 972-976 ◽  
Author(s):  
YOUNG H. KIM ◽  
CHAD GOODMAN ◽  
ELAN OMESSI ◽  
VICTOR RIVERA ◽  
MICHAEL W. KATTAN ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Multiple Sclerosis ◽  
Magnetic Resonance ◽  
Imaging Findings ◽  
Resonance Imaging ◽  
Cranial Magnetic Resonance Imaging

scholarly journals Magnetic resonance imaging findings of high-grade ductal carcinoma in situ of the male breast: A case report

2018 ◽  
Vol 6 ◽  
pp. 2050313X1878172
Author(s):  
Florian Reinhardt ◽  
Britta Mathys ◽  
Petra Reinecke ◽  
Hans Neubauer ◽  
Tanja Fehm ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Ductal Carcinoma In Situ ◽  
Carcinoma In Situ ◽  
Ductal Carcinoma ◽  
High Grade ◽  
Imaging Findings ◽  
Resonance Imaging ◽  
History Of

Ductal carcinoma in situ in men is incredibly rare and detection by conventional mammography and ultrasound is often challenging. We report an unusual case of a 50-year-old male, with no family history of breast cancer, who presented with an 8-year history of left-sided breast pain and recurrent bloody nipple discharge without any significant suspicious imaging features in mammography and targeted high-resolution ultrasound. Breast magnetic resonance imaging was performed as an adjunct modality. Magnetic resonance imaging findings revealed a suspicious retroareolar non-mass abnormality of segmental, linear and dendritic pattern, which was highly suspicious for a ductal carcinoma in situ. Stereotactic guided biopsy and subsequent mastectomy were consistent with pure high-grade ductal carcinoma in situ of the left breast. Overall, this case highlights the challenges in diagnosing ductal carcinoma in situ in men and demonstrates the importance for further investigating clinical suspicions of the male breast.

Diagnosis of Multiple Sclerosis

2016 ◽  
Author(s):  
Loren A. Rolak
Keyword(s):  
Magnetic Resonance Imaging ◽  
Multiple Sclerosis ◽  
Magnetic Resonance ◽  
Imaging Study ◽  
Progressive Multiple Sclerosis ◽  
Primary Progressive Multiple Sclerosis ◽  
Imaging Findings ◽  
Resonance Imaging ◽  
Mcdonald Criteria ◽  
Highly Sensitive

Because no laboratory test or imaging study is both highly sensitive and highly specific for multiple sclerosis, some uncertainty often accompanies the diagnosis. Various guidelines have been developed to assist the clinician, including the much-modified and commonly used McDonald criteria. Typical features of the history, the physical examination, and magnetic resonance imaging findings usually allow for a secure diagnosis. However, limitations inherent in any testing modality still pose challenges. This is especially true for diagnosis of primary progressive multiple sclerosis because the sensitivity and specificity of the evaluations are lower.

scholarly journals Oligoclonal bands increase the specificity of MRI criteria to predict multiple sclerosis in children with radiologically isolated syndrome

2019 ◽  
Vol 5 (1) ◽  
pp. 205521731983666 ◽  
Author(s):  
Naila Makhani ◽  
Christine Lebrun ◽  
Aksel Siva ◽  
Sona Narula ◽  
Evangeline Wassmer ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Multiple Sclerosis ◽  
Cerebrospinal Fluid ◽  
Magnetic Resonance ◽  
Diagnostic Criteria ◽  
Clinical Event ◽  
Oligoclonal Bands ◽  
Resonance Imaging ◽  
Diagnostic Indices ◽  
Radiologically Isolated Syndrome

Background Steps towards the development of diagnostic criteria are needed for children with the radiologically isolated syndrome to identify children at risk of clinical demyelination. Objectives To evaluate the 2005 and 2016 MAGNIMS magnetic resonance imaging criteria for dissemination in space for multiple sclerosis, both alone and with oligoclonal bands in cerebrospinal fluid added, as predictors of a first clinical event consistent with central nervous system demyelination in children with radiologically isolated syndrome. Methods We analysed an international historical cohort of 61 children with radiologically isolated syndrome (≤18 years), defined using the 2010 magnetic resonance imaging dissemination in space criteria (Ped-RIS) who were followed longitudinally (mean 4.2 ± 4.7 years). All index scans also met the 2017 magnetic resonance imaging dissemination in space criteria. Results Diagnostic indices (95% confidence intervals) for the 2005 dissemination in space criteria, with and without oligoclonal bands, were: sensitivity 66.7% (38.4–88.2%) versus 72.7% (49.8–89.3%); specificity 83.3% (58.6–96.4%) versus 53.9% (37.2–69.9%). For the 2016 MAGNIMS dissemination in space criteria diagnostic indices were: sensitivity 76.5% (50.1–93.2%) versus 100% (84.6–100%); specificity 72.7% (49.8–89.3%) versus 25.6% (13.0–42.1%). Conclusions Oligoclonal bands increased the specificity of magnetic resonance imaging criteria in children with Ped-RIS. Clinicians should consider testing cerebrospinal fluid to improve diagnostic certainty. There is rationale to include cerebrospinal fluid analysis for biomarkers including oligoclonal bands in planned prospective studies to develop optimal diagnostic criteria for radiologically isolated syndrome in children.

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