Open-Ring Enhancement in Pseudotumoral Multiple Sclerosis: Important Radiological Aspect

Introduction. Observation of open-ring enhancement in magnetic resonance imaging (MRI) is considered a specificity marker for diagnosing pseudotumoral multiple sclerosis (MS). This finding is of great value in the differential diagnosis of tumefactive lesions.Case Report. We describe a 55-year-old white woman, with previous history of ovarian cancer and recent history of fatigue and bilateral retroorbital pain. Important bilateral visual impairment evolved over one month. Physical examination detected the presence of right homonymous hemianopia. Cranial MRI showed an expanding lesion with open-ring enhancement. Given the range of diagnostic possibilities, a stereotactic biopsy was performed, and histopathological examination was consistent with an active demyelinating disease. The patient was treated with 1 g of methylprednisolone and symptoms improved following a significant reduction in the lesion.Conclusions. We highlight the MRI results suggestive of pseudotumoral MS, especially open-ring enhancement, which is an important radiologic aspect to diagnosis and can assist in avoiding unnecessary biopsies.

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Symptomatic spinal cord metastasis of glioblastoma multiforme

JBNC - JORNAL BRASILEIRO DE NEUROCIRURGIA ◽

10.22290/jbnc.v23i3.1193 ◽

2018 ◽

Vol 23 (3) ◽

pp. 234-237

Author(s):

Emerson Magno F. De Andrade ◽

Sérgio De Freitas ◽

Antônio Carlos Montanaro

Keyword(s):

Spinal Cord ◽

Glioblastoma Multiforme ◽

Histopathological Examination ◽

Spinal Metastasis ◽

Previous History ◽

Leg Pain ◽

Resonance Imaging ◽

History Of ◽

Spinal Cord Metastasis ◽

Magnetic Resonance Imaging Mri

Symptomatic spinal cord metastasis from glioblastoma multiforme (GBM) has rarely been reported in the literature. We report the case of a 27-year-old man that presented with back and bilateral leg pain nine months after the primarydiagnosis of intracranial GBM. A magnetic resonance imaging (MRI) of the lumbar spine showed a L1-L2 tumor that was removed successfully and histopathological examination was consistent with GBM metastasis. Spinal metastasis should be investigated and included in the differential diagnosis if a patient with a previous history of intracranial GBM presentswith spinal symptoms.

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Multiple sclerosis risk in radiologically uncovered asymptomatic possible inflammatory-demyelinating disease

Multiple Sclerosis Journal ◽

10.1177/1352458509106214 ◽

2009 ◽

Vol 15 (8) ◽

pp. 918-927 ◽

Cited By ~ 52

Author(s):

A Siva ◽

S Saip ◽

A Altintas ◽

A Jacob ◽

BM Keegan ◽

...

Keyword(s):

Multiple Sclerosis ◽

Demyelinating Disease ◽

Clinical Symptoms ◽

Tertiary Care ◽

Similar Rate ◽

Randomized Controlled Studies ◽

History Of ◽

Magnetic Resonance Imaging Mri ◽

Mri Study

Background Natural history of patients with incidentally discovered lesions that fulfill magnetic resonance imaging (MRI) criteria for multiple sclerosis (MS) in the absence of objective clinical symptoms suggestive of central nervous system (CNS) inflammatory-demyelinating disease is not well defined. Objective We evaluated the risk of developing symptomatic MS in patients with radiologically uncovered asymptomatic possible inflammatory-demyelinating disease (RAPIDD). Methods We identified and longitudinally followed a cohort of 22 patients from two tertiary care MS centers: Istanbul University, Cerrahpasa School of Medicine, Istanbul, Turkey, and Mayo Clinic, Rochester, Minnesota, after an initial MRI study fulfilling the Barkhof–Tintore MRI criteria completed for other reasons unrelated to MS. Results Eight of 22 patients developed an objective clinical symptom consistent with a CNS inflammatory-demyelinating syndrome and fulfilled dissemination in space and time criteria for definite MS. Median age at the time of diagnosis of MS was 44.8 years (range 28.3–71.4 years). Time taken for the development of definite MS was studied by survival analysis. Cumulative event rates were; 12 months: 9%, 24 months: 15%, 36 months: 30.4%, and 60 months: 44.6%. Six of 22 patients were followed beyond 60 months. Two of these six patients developed MS later (at 66 and 112 months, respectively). Three patients remained asymptomatic despite follow-up of 10 years. Conclusions Patients with RAPIDD develop MS at a similar rate to treated patients (and less frequently than placebo groups) with clinically isolated syndromes from prior randomized controlled studies. Some patients with RAPIDD continue to have radiological evolution of subclinical disease without MS symptoms despite long follow-up periods.

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Symptomatic spinal cord metastasis of glioblastoma multiforme

JBNC - JORNAL BRASILEIRO DE NEUROCIRURGIA ◽

10.22290/jbnc.v22i2.961 ◽

2018 ◽

Vol 22 (2) ◽

pp. 44-47

Author(s):

Emerson Magno F. De Andrade ◽

Sérgio De Freitas ◽

Antônio Carlos Montanaro

Keyword(s):

Spinal Cord ◽

Glioblastoma Multiforme ◽

Histopathological Examination ◽

Spinal Metastasis ◽

Previous History ◽

Primary Diagnosis ◽

Leg Pain ◽

History Of ◽

Spinal Cord Metastasis ◽

Magnetic Resonance Imaging Mri

Symptomatic spinal cord metastasis from glioblastoma multiforme (GBM) has rarely been reported in the literature. We report the case of a 27-year-old man who presented with back and bilateral leg pain nine months after the primary diagnosis of intracranial GBM. A magnetic resonance imaging (MRI) of the lumbar spine showed a L1-L2 tumor that was removed successfully and histopathological examination was consistent with GBM metastasis. Spinal metastasis should be investigated and included in the differential diagnosis in a patient with a previous history of intracranial GBM presenting with spinal symptoms.

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Popliteal artery thrombosis secondary to a tibial osteochondroma

VASA ◽

10.1024/0301-1526/a000101 ◽

2011 ◽

Vol 40 (3) ◽

pp. 251-255 ◽

Cited By ~ 4

Author(s):

Gruber-Szydlo ◽

Poreba ◽

Belowska-Bien ◽

Derkacz ◽

Badowski ◽

...

Keyword(s):

Case Report ◽

Magnetic Resonance Angiography ◽

Popliteal Artery ◽

Doppler Ultrasonography ◽

Histopathological Examination ◽

Previous History ◽

Plain Radiography ◽

Artery Thrombosis ◽

History Of ◽

The Right

Popliteal artery thrombosis may present as a complication of an osteochondroma located in the vicinity of the knee joint. This is a case report of a 26-year-old man with symptoms of the right lower extremity ischaemia without a previous history of vascular disease or trauma. Plain radiography, magnetic resonance angiography and Doppler ultrasonography documented the presence of an osteochondrous structure of the proximal tibial metaphysis, which displaced and compressed the popliteal artery, causing its occlusion due to intraluminal thrombosis..The patient was operated and histopathological examination confirmed the diagnosis of osteochondroma.

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A Rare Case of Spinal Leprosy Mimicking Spinal Tuberculosis

International Journal of Human and Health Sciences (IJHHS) ◽

10.31344/ijhhs.v0i0.151 ◽

2019 ◽

pp. 33

Author(s):

K Thuraikumar ◽

V Naveen ◽

Mustaqim A ◽

Arieff AA ◽

K Shri ◽

...

Keyword(s):

Back Pain ◽

Soft Tissue ◽

Histopathological Examination ◽

Posterior Instrumentation ◽

Spinal Tuberculosis ◽

Previous History ◽

Skin Lesions ◽

Titanium Implants ◽

Paravertebral Abscess ◽

History Of

Introduction: Spinal tuberculosis is the most common manifestation of extrapulmonar y tuberculosis. A combination of leprosy and tuberculosis is a rare entity.Case report: A 44-year-old male patient working as a laborer presented to our hospital with complaints of severe back pain and swelling over the back, difficulty in walking, associated with constitutional symptoms. On admission, he was febrile and had leukocytosis. Initial spine X-ray showed end plate destruction and increase in soft tissue shadow at the level of T8-T9. CT spine revealed thoracic paravertebral collection extending from T7 to T9 levels, suggest ive of tuberculous spondylitis with cold abscess. Patient refused a transpedicular biopsy and was started on anti-tubercular therapy. Two weeks after commencement of treatment, he developed worsening back pain and weakness of the lower extremities. MRI spine showed a paravertebral abscess and posterior soft tissue edema involving level of T7 to T11. Patient underwent a posterior decompression, debridement and posterior instrumentation. He was discharged well, there was improvement of his lower limb power. Upon clinic review, he complained of multiple hyperpigmented, painless, nonpruritic skin lesions over the trunk and back. No previous history of eczema, psoriasis and Tinea corporis. Given the history of allergy, initial impression was hypersensitivity reaction towards the titanium implants, and he was started on anti-histamines. However, there was no improvements seen. Histopathological examination of skin lesions revealed presence of granuloma within the dermis layer, composed of epitheloid, histiocytes, lymphocytes and plasma cells. Wade-Fite stain for Mycobacterium leprae is positive. Slit skin smear shows multibacillary leprosy. Patient was started on multidrug therapy (rifampicin, clofazimine and dapsone) for 1 year. He has recovered well.International Journal of Human and Health Sciences Supplementary Issue: 2019 Page: 33

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Serum neurofilament levels reflect outer retinal layer changes in multiple sclerosis

Therapeutic Advances in Neurological Disorders ◽

10.1177/17562864211003478 ◽

2021 ◽

Vol 14 ◽

pp. 175628642110034

Author(s):

Caspar B. Seitz ◽

Falk Steffen ◽

Muthuraman Muthuraman ◽

Timo Uphaus ◽

Julia Krämer ◽

...

Keyword(s):

Multiple Sclerosis ◽

Optic Neuritis ◽

Previous History ◽

Supervised Machine Learning ◽

Support Vector ◽

Retinal Layer ◽

Neurofilament Light Chain ◽

Neurofilament Light ◽

Retinal Layers ◽

History Of

Background: Serum neurofilament light chain (sNfL) and distinct intra-retinal layers are both promising biomarkers of neuro-axonal injury in multiple sclerosis (MS). We aimed to unravel the association of both markers in early MS, having identified that neurofilament has a distinct immunohistochemical expression pattern among intra-retinal layers. Methods: Three-dimensional (3D) spectral domain macular optical coherence tomography scans and sNfL levels were investigated in 156 early MS patients (female/male: 109/47, mean age: 33.3 ± 9.5 years, mean disease duration: 2.0 ± 3.3 years). Out of the whole cohort, 110 patients had no history of optic neuritis (NHON) and 46 patients had a previous history of optic neuritis (HON). In addition, a subgroup of patients ( n = 38) was studied longitudinally over 2 years. Support vector machine analysis was applied to test a regression model for significant changes. Results: In our cohort, HON patients had a thinner outer plexiform layer (OPL) volume compared to NHON patients ( B = −0.016, SE = 0.006, p = 0.013). Higher sNfL levels were significantly associated with thinner OPL volumes in HON patients ( B = −6.734, SE = 2.514, p = 0.011). This finding was corroborated in the longitudinal subanalysis by the association of higher sNfL levels with OPL atrophy ( B = 5.974, SE = 2.420, p = 0.019). sNfL levels were 75.7% accurate at predicting OPL volume in the supervised machine learning. Conclusions: In summary, sNfL levels were a good predictor of future outer retinal thinning in MS. Changes within the neurofilament-rich OPL could be considered as an additional retinal marker linked to MS neurodegeneration.

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Progressive multifocal leukoencephalopathy in a patient with occult hypogammaglobulinemia experiencing bilateral visual impairment

European Journal of Ophthalmology ◽

10.1177/1120672121990535 ◽

2021 ◽

pp. 112067212199053

Author(s):

Sameera Hettipathirannahelage ◽

Sidath Wijetilleka ◽

Hugh Jewsbury

Keyword(s):

Progressive Multifocal Leukoencephalopathy ◽

Visual Impairment ◽

Demyelinating Disease ◽

Parietal Lobe ◽

Previous History ◽

White Matter Lesions ◽

Slit Lamp ◽

Slit Lamp Examination ◽

History Of ◽

Ishihara Test

Introduction: Progressive multifocal leukoencephalopathy (PML) is a rare, lethal, demyelinating disease classically seen in profoundly immunosuppressed individuals. It is caused by intracerebral infection by John Cunningham polyomavirus (JCV). We report a rare case of PML in a man with presumed immunocompetence at presentation experiencing bilateral painless visual impairment. Case Description: A 60-year-old man with a 3-week history of bilateral painless visual impairment attended our ophthalmology department. Unusually, he navigated around the room well and was able to read 4 of 13 Ishihara test plates in spite of a best-corrected visual acuity of counting fingers at 1 m bilaterally. Slit lamp examination, routine blood tests and optical coherence tomography (OCT) of the maculae and discs were unremarkable. Diffuse hyperintense white matter lesions on T2-weighted magnetic resonance imaging of the brain and detection of JCV within the parietal lobe tissue obtained by biopsy confirmed PML. Additional investigations identified an underlying hypogammaglobulinaemia, which may have initiated PML. He received intravenous immunoglobulin but passed away 2 months after diagnosis. Conclusions: To our knowledge this case is one of only a handful worldwide to describe PML developing in a patient with presumed immunocompetence at presentation – there was no previous history of recurrent, chronic, or atypical infections. There has only been one other report of visual symptoms presenting as the primary complaint. The case illustrates the importance of ruling out organic, central nervous system pathology in patients presenting with visual loss and normal objective visual function tests such as slit lamp examination and OCT.

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De novo convulsive status epilepticus in patients with multiple sclerosis treated with dalfampridine

Multiple Sclerosis Journal ◽

10.1177/1352458518790379 ◽

2018 ◽

Vol 25 (4) ◽

pp. 618-621 ◽

Cited By ~ 3

Author(s):

Emilie Panicucci ◽

Mikael Cohen ◽

Veronique Bourg ◽

Fanny Rocher ◽

Pierre Thomas ◽

...

Keyword(s):

Multiple Sclerosis ◽

Status Epilepticus ◽

De Novo ◽

Case Reports ◽

Brain Magnetic Resonance Imaging ◽

Convulsive Status Epilepticus ◽

Biological Tests ◽

History Of ◽

Magnetic Resonance Imaging Mri ◽

History Of Epilepsy

Background: Dalfampridine extended release (DAL) is a broad-spectrum voltage-gated potassium channel blocker that is indicated in multiple sclerosis to improve the nerve conduction of demyelinated axons. Seizures are a known side effect of DAL, which is contraindicated in patients with a history of epilepsy. Objective: Three cases of multiple sclerosis (MS) with de novo convulsive status epilepticus (CSE) probably related to dalfampridine administration are described. Methods: No patients had a history of seizures or renal impairment. Biological tests were normal. A brain magnetic resonance imaging (MRI) showed diffuse cortical and subcortical atrophy without active inflammatory lesions. Results: All three patients presented with CSE that was attributed to DAL and so was discontinued. Conclusion: These case reports illustrate that, aside from seizures, de novo CSE is a potential complication of MS patients treated with DAL.

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Discrepancies in the interpretation of clinical symptoms and signs in the diagnosis of multiple sclerosis. A proposal for standardization

Multiple Sclerosis Journal ◽

10.1191/1352458505ms1149oa ◽

2005 ◽

Vol 11 (2) ◽

pp. 227-231 ◽

Cited By ~ 23

Author(s):

Bernard MJ Uitdehaag ◽

Ludwig Kappos ◽

Lars Bauer ◽

Mark S Freedman ◽

David Miller ◽

...

Keyword(s):

Multiple Sclerosis ◽

Demyelinating Disease ◽

Clinical Symptoms ◽

Clinical Findings ◽

Large Trial ◽

Mri Findings ◽

Mcdonald Criteria ◽

Magnetic Resonance Imaging Mri ◽

Eligibility Assessment

The new McDonald diagnostic criteria for multiple sclerosis (MS) incorporate detailed criteria for the interpretation and classification of magnetic resonance imaging (MRI) findings, but, in contrast, provide no instructions for the interpretation of clinical findings. Because MS according to the McDonald criteria is one of the primary endpoints in a large trial enrolling patients after the first manifestation suggestive for a demyelinating disease (BENEFIT study), it was decided to organize a centralized eligibility assessment for this trial. During this eligibility assessment it was observed that there were marked inconsistencies in the decisions of participating neurologists with respect to the classification of clinical symptoms as being caused by one or more lesions provoking discussions in about one in every five patients. This paper describes these inconsistencies and their sources, and recommends a systematic approach that attempts to reduce the variability in interpreting clinical findings.

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Orbital Schwannoma: Case Report and Review

Arquivos Brasileiros de Neurocirurgia Brazilian Neurosurgery ◽

10.1055/s-0039-1693683 ◽

2019 ◽

Vol 38 (03) ◽

pp. 199-202 ◽

Cited By ~ 1

Author(s):

Ricardo Lourenço Caramanti ◽

Mário José Goes ◽

Feres Chaddad ◽

Lucas Crociati Meguins ◽

Dionei Freitas de Moraes ◽

...

Keyword(s):

Clinical Symptoms ◽

Previous History ◽

Mass Effect ◽

Complete Resection ◽

High Signal ◽

Resonance Imaging ◽

History Of Disease ◽

Orbital Pain ◽

History Of ◽

Magnetic Resonance Imaging Mri

AbstractOrbital schwannomas are rare, presenting a rate of incidence between 1 and 5% of all orbital lesions. Their most common clinical symptoms are promoted by mass effect, such as orbital pain and proptosis. The best complementary exam is the magnetic resonance imaging (MRI), which shows low signal in T1, high signal in T2, and heterogeneous contrast enhancement. The treatment of choice is surgical, with adjuvant radiotherapy if complete resection is not possible. We report the case of a 24-year-old male patient with orbital pain and proptosis, without previous history of disease. The MRI showed a superior orbital lesion compatible with schwannoma, which was confirmed by biopsy after complete resection using a fronto-orbital approach.

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