scholarly journals Grey matter involvement by focal cervical spinal cord lesions is associated with progressive multiple sclerosis

2015 ◽  
Vol 22 (7) ◽  
pp. 910-920 ◽  
Author(s):  
Hugh Kearney ◽  
Katherine A Miszkiel ◽  
Marios C Yiannakas ◽  
Daniel R Altmann ◽  
Olga Ciccarelli ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Spinal Cord ◽  
Grey Matter ◽  
Cervical Spinal Cord ◽  
Spinal Cord Lesion ◽  
Cervical Cord ◽  
Focal Lesions ◽  
Lateral Column ◽  
Cord Lesion

Background: The in vivo relationship of spinal cord lesion features with clinical course and function in multiple sclerosis (MS) is poorly defined. Objective: The objective of this paper is to investigate the associations of spinal cord lesion features on MRI with MS subgroup and disability. Methods: We recruited 120 people: 25 clinically isolated syndrome, 35 relapsing–remitting (RR), 30 secondary progressive (SP), and 30 primary progressive (PP) MS. Disability was measured using the Expanded Disability Status Scale. We performed 3T axial cervical cord MRI, using 3D-fast-field-echo and phase-sensitive-inversion-recovery sequences. Both focal lesions and diffuse abnormalities were recorded. Focal lesions were classified according to the number of white matter (WM) columns involved and whether they extended to grey matter (GM). Results: The proportion of patients with focal lesions involving at least two WM columns and extending to GM was higher in SPMS than in RRMS ( p = 0.03) and PPMS ( p = 0.015). Diffuse abnormalities were more common in both PPMS and SPMS, compared with RRMS (OR 6.1 ( p = 0.002) and 5.7 ( p = 0.003), respectively). The number of lesions per patient involving both the lateral column and extending to GM was independently associated with disability ( p < 0.001). Conclusions: More extensive focal cord lesions, extension of lesions to GM, and diffuse abnormalities are associated with progressive MS and disability.

Intraoperative MR imaging in a case of a cervical spinal cord lesion

2011 ◽  
Vol 14 (6) ◽  
pp. 754-757 ◽  
Author(s):  
David Netuka ◽  
Svatopluk Ostrý ◽  
Tomáš Belšán ◽  
Filip Kramář ◽  
Vladimír Beneš
Keyword(s):  
Spinal Cord ◽  
Mr Imaging ◽  
Cavernous Malformation ◽  
Cervical Spinal Cord ◽  
Spinal Cord Lesion ◽  
Cervical Cord ◽  
Cervical Pain ◽  
Neck Flexion ◽  
Before And After ◽  
Cord Lesion

The aim of this article is to describe the feasibility of performing intraoperative MR imaging in patients with spinal cord lesions and the potential value of this technique. The authors report a case involving a 28-year-old man who presented with chronic cervical pain and pain along the ulnar side of the forearms during neck flexion. Findings on clinical examination were normal, but MR imaging revealed a multicystic cervical spinal cord lesion. Surgery was undertaken to open the cysts, evacuate old blood, and search for pathological tissue. Intraoperative MR imaging showed that the caudal cyst was not opened, and surgery was therefore continued. The caudal cyst was fenestrated and a suspected small cavernous malformation was removed. Electrophysiological monitoring was performed both before and after the intraoperative MR imaging. The use of intraoperative MR imaging changed the strategy of the procedure and helped the surgeon to safely enter all the cysts in the cervical cord.

Influence of CNS T2-focal lesions on cervical cord atrophy and disability in multiple sclerosis

2019 ◽  
Vol 26 (11) ◽  
pp. 1402-1409 ◽  
Author(s):  
Emanuele Pravatà ◽  
Paola Valsasina ◽  
Claudio Gobbi ◽  
Chiara Zecca ◽  
Gianna C Riccitelli ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Spinal Cord ◽  
Cervical Spinal Cord ◽  
Neurological Impairment ◽  
Cervical Cord ◽  
Focal Lesions ◽  
Cross Sectional ◽  
Thoracic Spinal Cord ◽  
Thoracic Spinal ◽  
Upper Thoracic

Background: Mechanisms associated with cervical spinal cord (CSC) and upper thoracic spinal cord (TSC) atrophy in multiple sclerosis (MS) are poorly understood. Objective: To assess the influence of brain, CSC and TSC T2-hyperintense lesions on cord atrophy and disability in MS. Methods: Thirty-four MS patients underwent 3T brain, cervical and thoracic cord magnetic resonance imaging (MRI) and Expanded Disability Status Scale (EDSS) score assessment. CSC/TSC lesion number and volume (LV), whole-brain and cortico-spinal tract (CST) LVs were obtained. Normalized whole CSC and upper TSC cross-sectional areas (CSAn) were also derived. Age- and sex-adjusted regression models assessed associations of brain/cord lesions with CSAn and EDSS and identified variables independently associated with CSAn and EDSS with a stepwise variable selection. Results: CSC CSAn (β = −0.36, p = 0.03) and TSC CSAn (β = −0.60, p < 0.001) were associated with CSC T2 LV. EDSS (median = 3.0) was correlated with CSC T2 LV (β = 0.42, p = 0.01), brain (β = 0.34, p = 0.04) and CST LV (β = 0.35, p = 0.03). The multivariate analysis retained CSC LV as significant predictor of CSC CSAn ( R2 = 0.20, p = 0.023) and TSC CSAn ( R2 = 0.51, p < 0.001) and retained CSC and CST LVs as significant predictors of EDSS ( R2 = 0.55, p = 0.001). Conclusions: CSC LV is an independent predictor of cord atrophy. When neurological impairment is relatively mild, central nervous system (CNS) lesion burden is a better correlate of disability than atrophy.

A DTI study of the spinal cord lesion in patients with multiple sclerosis during the follow-up after relapse

2016 ◽  
Vol 116 (2. Vyp. 2) ◽  
pp. 21 ◽  
Author(s):  
S. N. Morozova ◽  
V. V. Bryukhov ◽  
O. V. Trifonova ◽  
E. I. Kremneva ◽  
M. V. Krotenkova
Keyword(s):  
Multiple Sclerosis ◽  
Spinal Cord ◽  
Spinal Cord Lesion ◽  
Cord Lesion

Spinal cord oligodendroglioma with 1p and 19q deletions presenting with cerebral oligodendrogliomatosis

2009 ◽  
Vol 10 (6) ◽  
pp. 557-563 ◽  
Author(s):  
Kern H. Guppy ◽  
Paul T. Akins ◽  
Gregory S. Moes ◽  
Michael D. Prados
Keyword(s):  
Spinal Cord ◽  
Tumor Cells ◽  
Cervical Spinal Cord ◽  
Cervical Cord ◽  
Meningeal Enhancement ◽  
Who Grade ◽  
Term Survival ◽  
Radiographic Findings ◽  
Grade Ii ◽  
Cord Lesion

Oligodendroglioma of the spinal cord is a rare tumor that most often presents with spinal cord symptoms. The authors present a case of spinal cord oligodendroglioma that was associated with cerebral rather than spinal cord symptoms. A 30-year-old woman developed nausea, vomiting, and severe headaches. Magnetic resonance imaging of the brain showed meningeal enhancement. The patient underwent a craniotomy with biopsies of the meninges and brain. The biopsy findings revealed an abnormal arachnoid thickening without tumor cells. The patient later developed hydrocephalus and underwent shunt placement. Cerebrospinal fluid cytological findings were negative for tumor cells or infection. She was found to have a cervical cord lesion at C3–4 that was initially nonenhancing but later enhanced after Gd administration. Biopsy of the cord lesion with partial resection showed a WHO Grade II oligodendroglioma with 1p and 19q deletions determined by fluorescence in situ hybridization. Neurooncological treatment with tumor radiation and temozolomide (Temodor) resulted in improvement in radiographic findings, symptoms, and long-term survival. This paper presents an extensive review of the literature, which revealed only 2 other reported cases of cerebral symptoms in adults that preceded spinal cord symptoms in a patient with oligodendroglioma of the spinal cord. It is also the first reported case of oligodendrogliomatosis due to a cervical spinal cord oligodendroglioma with 1p and 19q deletions.

Expansile, enhancing cervical cord lesion with an associated syrinx secondary to demyelination

2007 ◽  
Vol 6 (1) ◽  
pp. 52-56 ◽  
Author(s):  
Allen Waziri ◽  
Jean-Paul Vonsattel ◽  
Michael G. Kaiser ◽  
Richard C. E. Anderson
Keyword(s):  
Spinal Cord ◽  
Demyelinating Disease ◽  
Cervical Spinal Cord ◽  
Inpatient Rehabilitation ◽  
Tissue Loss ◽  
Cervical Cord ◽  
High Dose ◽  
Histopathological Analysis ◽  
Dural Graft ◽  
Cord Lesion

✓The authors describe the case of a patient with an enhancing, intramedullary cervical spinal cord lesion and associated syrinx. Biopsy sampling of the cervical lesion was performed, and the histological findings were consistent with a demyelinating process supporting the diagnosis of multiple sclerosis (MS). Syrinx formation associated with demyelinating disease has only been described in isolated cases, almost exclusively in Japanese patients with MS. A 22-year-old woman of Caribbean descent presented with a subacute, progressive myelopathy including symptoms of pain and weakness in all extremities, bladder incontinence, and the inability to ambulate. Magnetic resonance imaging of the brain and spinal cord demonstrated an enlarged cervical cord with enhancement and central cavitation consistent with a syrinx. The patient underwent a C3–7 laminoplasty and placement of a dural graft for cord decompression as well as fenestration of the central syrinx. Biopsy sampling of the lesion was performed, and the histopathological analysis, in conjunction with subsequent laboratory and diagnostic testing, supported the diagnosis of demyelinating disease. After treatment with a course of high-dose dexamethasone and inpatient rehabilitation therapy, the patient demonstrated significant clinical improvement. Spinal cord involvement is not uncommon in patients with demyelinating disease; however, enhancing lesions associated with extensive tissue loss and syrinx formation have rarely been reported. For the consulting neurological surgeon, demyelinating disease should be included in the differential diagnosis of such lesions given the level of complexity and risk to the patient associated with open biopsy of the spinal cord.

scholarly journals Comparison of proton density MRI and T2-Weighted Fast Echo for The Detection of Cervical Spinal Cord Multiple Sclerosis Lesions

2019 ◽  
Vol 60 (4) ◽  
pp. 195-201
Author(s):  
Iman Emad Ahmed ◽  
Hayder Kareem Al-Jaberi ◽  
Mohammed M. Jawad Alkahlissi
Keyword(s):  
Multiple Sclerosis ◽  
Spinal Cord ◽  
Cervical Spinal Cord ◽  
Spin Echo ◽  
Fast Spin Echo ◽  
Cervical Cord ◽  
Proton Density ◽  
P Value ◽  
Cross Sectional ◽  
Fast Spin

Background: The prevalence of spinal cord lesions is high in multiple sclerosis particularly in the cervical cord, and their detection can assist in both the diagnosis and follow-up of the patients. For spinal multiple sclerosis, MRI is considered the first line investigation. Objective: To evaluate the value of sagittal 1.5 Tesla proton density-fast spin echo (PD-FSE) MRI in the detecting and increasing conspicuity of multiple sclerosis lesions in cervical cord in comparison with sagittal T2 fast spin-echo (T2-FSE) MRI. Patients and Methods: A cross sectional study carried out from 3rd of January 2017 to 1st of January 2018 in the MRI department of Al-Imamein Al-Kadhimein Medical City, and included 60 selected patients with a known diagnosis of multiple sclerosis. All patients were examined with 1.5 T sagittal PD-FSE, T2-FSE and axial gradient recalled-echo (GRE) MRI. Results: Sixty patients with cervical multiple sclerosis were enrolled in the study, 146 (100%) lesions were detected by PD-FSE imaging, while T2 detected 105 (71.9%), 41 more lesions (28%) were detected by PD-FSE imaging, (P-value <0.001). All extra lesions were confirmed on axial imaging. In 13 patients (21.6%) one lesion or more had been detected on sagittal PD-FSE imaging while on sagittal T2-FSE imaging, no lesion were detected. On PD-FSE imaging, 17 long lesions were detected in 16 patients (26.7%) while 7 long lesions in 7 patients (11.7%) were detected by T2-FSE imaging. So, in 9 patients (16.7%) 10 lesions were detected as long in PD-FSE while short lesion in T2– FSE, the detection of long lesions by PD-FSE was significantly higher than in T2– FSE (100% vs 71.9% with p- value of 0.002). The mean lesion contrast to cord ratio was significantly higher in PD-FSE as compared to T2-FSE (PD-FSE, 79±2.0, against T2-FSE, 61± 2.6; P-value <0.001). Conclusion: Sagittal proton density was more efficient and more accurate in the detection of cervical cord lesions than sagittal T2-FSE sequence, when used in conjunction with sagittal T2-FSE; it can raise the diagnostic assurance via improving the visualization of the lesions. 

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