An uncommon first manifestation of multiple sclerosis: Tako-Tsubo cardiomyopathy

2016 ◽  
Vol 22 (6) ◽  
pp. 842-846 ◽  
Author(s):  
Luciana Midaglia ◽  
Jesús M Juega Mariño ◽  
Jaume Sastre-Garriga ◽  
Alex Rovira ◽  
Angela Vidal-Jordana ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Brain Magnetic Resonance Imaging ◽  
Oligoclonal Bands ◽  
Magnetic Resonance Imaging Scan ◽  
Intravenous Methylprednisolone ◽  
Ventricular Failure ◽  
Demyelinating Lesions ◽  
Tako Tsubo Cardiomyopathy ◽  
Excessive Secretion ◽  
Disease Modifying Treatment

Background: Clinically isolated syndromes affecting the brainstem may present with rare manifestations such as neurogenic pulmonary oedema (NPO). Objectives: We present the case of a 23 year-old man with NPO caused by Tako-Tsubo cardiomyopathy (TTC) as a first manifestation of multiple sclerosis (MS). Methods and Results: A brain magnetic resonance imaging scan at admission showed multiple supra and infratentorial white matter inflammatory demyelinating lesions. This examination was repeated 2 and 4 weeks after symptoms onset and active lesions showing contrast uptake were identified, two of them involving the pons and the medulla oblongata, probably affecting the solitary tract nucleus. Cerebrospinal fluid oligoclonal bands were detected. The patient was treated with a 3-day course of 1g intravenous methylprednisolone presenting a significant and progressive improvement. The proposed underlying physiopathology is an excessive secretion of catecholamines resulting in myocardial stunning and ventricular failure. Two months later he developed optic neuritis and disease-modifying treatment was initiated. Conclusions: Clinicians should consider a possible neurological origin of TTC, and according to the clinical characteristics of the patient, MS may be suspected.

scholarly journals Pediatric Multiple Sclerosis in Portugal: A Multicentre Study

2016 ◽  
Vol 29 (7-8) ◽  
pp. 425 ◽  
Author(s):  
Ana Sofia Correia ◽  
Luís Augusto ◽  
Joana Meireles ◽  
Joana Pinto ◽  
Ana Paula Sousa
Keyword(s):  
Multiple Sclerosis ◽  
Cerebrospinal Fluid ◽  
Brain Magnetic Resonance Imaging ◽  
Oligoclonal Bands ◽  
Childhood Onset ◽  
Multicentric Study ◽  
Pediatric Multiple Sclerosis ◽  
Adolescent Groups ◽  
Reported Data ◽  
Cerebrospinal Fluid Pleocytosis

Introduction: Multiple sclerosis is most often diagnosed among young adults but less frequently it may present during childhood or adolescence. In Portugal, there has been only one previous single-center, pediatric multiple sclerosis study. The main objective was the evaluation of the demographic, clinical, laboratorial and neuroradiological characteristics of patients with pediatric-onset multiple sclerosis in Portugal. The secondary objectives were to compare the characteristics of childhood-onset multiple sclerosis and adolescent-onset multiple sclerosis and to characterize the treatments prescribed.Material and Methods: We performed a retrospective observational, multicentric study. We reviewed data of all patients with multiple sclerosis younger than 18 years at the onset of their first multiple sclerosis symptoms.Results: There were 46 patients (72% female) included with a mean age at diagnosis of 16.1 years. Six cases had childhood-onset and 40 cases had adolescence-onset. The median value of Expanded Disability Status Scale was two. Relapsing-remitting multiple sclerosis was most prevalent (98% of cases). In the cerebrospinal fluid study, 74% of patients had positive oligoclonal bands. Brain magnetic resonance imaging studies showed a predominant supratentorial involvement (98% of cases), whereas the cervical segment was the most frequently affected in the spinal cord. All the patients enrolled in the study underwent immunomodulatory therapy, 75% ofpatients with beta-interferon. Concerning differences between the childhood and the adolescent groups, we found a greater proportion of male patients and of individuals with cerebrospinal fluid pleocytosis among the childhood-onset group.Discussion: This study provides new data on pediatric multiple sclerosis characteristics in Portugal and our results are similar to previously reported data in other parts of the worldConclusion: This is the first multicentric study characterizing pediatric multiple sclerosis in Portugal. The mechanisms underlying the particularities of pediatric multiple sclerosis remain largely unknown and further studies are required.

Foreign accent syndrome as a first sign of multiple sclerosis

2009 ◽  
Vol 15 (9) ◽  
pp. 1123-1125 ◽  
Author(s):  
JB Chanson ◽  
S Kremer ◽  
F Blanc ◽  
C Marescaux ◽  
IJ Namer ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Right Hemisphere ◽  
Brain Mri ◽  
Photon Emission ◽  
Brain Magnetic Resonance Imaging ◽  
Foreign Accent ◽  
Oligoclonal Bands ◽  
Emission Computed Tomography ◽  
Initial Symptom ◽  
Foreign Accent Syndrome

Background Foreign accent syndrome (FAS) consists of a speech rhythm disorder different from dysarthia or aphasia. It is unusually met in multiple sclerosis (MS). Objective We report a case of FAS as an initial symptom of a MS. Methods A right-handed French woman developed an isolated German foreign accent. Brain magnetic resonance imaging (MRI), SPECT and analysis of CSF were performed. Results Brain MRI revealed a large hypersignal on T2-weighted images in the left prerolandic white matter. Single photon emission computed tomography showed a right prerolandic hypoperfusion. Unmatched oligoclonal bands in cerebrospinal fluid and occurrence of new abnormal hypersignals on the following MRI led us to diagnose MS. Conclusion FAS may be the first symptom of MS. It could result from extensive disturbances of brain function involving the right hemisphere.

Smoking is a risk factor for early conversion to clinically definite multiple sclerosis

2008 ◽  
Vol 14 (8) ◽  
pp. 1026-1030 ◽  
Author(s):  
F Di Pauli ◽  
M Reindl ◽  
R Ehling ◽  
F Schautzer ◽  
C Gneiss ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Risk Factor ◽  
Smoking Status ◽  
Brain Magnetic Resonance Imaging ◽  
Clinically Isolated Syndrome ◽  
Oligoclonal Bands ◽  
Time Interval ◽  
Increased Risk ◽  
Definite Multiple Sclerosis ◽  
Clinically Definite Multiple Sclerosis

Background Cigarette smoking increases the risk for development of multiple sclerosis and modifies the clinical course of the disease. In this study, we determined whether smoking is a risk factor for early conversion to clinically definite multiple sclerosis after a clinically isolated syndrome. Methods We included 129 patients with a clinically isolated syndrome, disseminated white-matter lesions on brain magnetic resonance imaging, and positive oligoclonal bands in the cerebrospinal fluid. The patients’ smoking status was obtained at the time of the clinically isolated syndrome. Results During a follow-up time of 36 months, 75% of smokers but only 51% of non-smokers developed clinically definite multiple sclerosis, and smokers had a significantly shorter time interval to their first relapse. The hazard ratio for progression to clinically definite multiple sclerosis was 1.8 (95% confidence interval, 1.2–2.8) for smokers compared with non-smokers ( P = 0.008). Conclusions Smoking is associated with an increased risk for early conversion to clinically definite multiple sclerosis after a clinically isolated syndrome, and our results suggest that smoking is an independent but modifiable risk factor for disease progression of multiple sclerosis. Therefore, it should be considered in the counseling of patients with a clinically isolated syndrome.

scholarly journals Ocular flutter as presenting manifestation of pediatric MOG antibody–associated demyelination: A case report

2018 ◽  
Vol 25 (1) ◽  
pp. 122-125 ◽  
Author(s):  
Marianthi Breza ◽  
Nikoletta Smyrni ◽  
Georgios Koutsis ◽  
Evangelos Anagnostou ◽  
John Tzartos ◽  
...  
Keyword(s):  
Brain Mri ◽  
Brain Magnetic Resonance Imaging ◽  
Oligoclonal Bands ◽  
Resonance Imaging ◽  
Ocular Flutter ◽  
Demyelinating Lesions ◽  
History Of ◽  
Mog Antibodies ◽  
Magnetic Resonance Imaging Mri ◽  
Csf Oligoclonal Bands

A 13-year-old girl presented with a 5-day history of oscillopsia. On examination, ocular flutter and mild cerebellar signs were found. Brain magnetic resonance imaging (MRI) revealed four periventricular and subcortical non-enhancing lesions. Cerebrospinal fluid (CSF) oligoclonal bands were negative. Neuroblastoma or other malignancies were not found. She responded well to a corticosteroid–intravenous immunoglobulin (IVIG) combination and remained symptom-free for 3 years until presenting again with isolated ocular flutter. Brain MRI at this time remained atypical for classic multiple sclerosis (MS) with a predominance of juxtacortical demyelinating lesions. CSF was positive for oligoclonal bands. Serum myelin oligodendrocyte glycoprotein (MOG) antibodies were present. Ocular flutter can be the presenting feature of MOG antibody–associated pediatric demyelination.

Hereditary Melkersson-Rosenthal syndrome and multiple sclerosis

2005 ◽  
Vol 11 (3) ◽  
pp. 364-366 ◽  
Author(s):  
J A Cabrera-Gómez ◽  
N Echazabal-Santana ◽  
Y Real-González ◽  
K Romero García ◽  
Manuel Junior Sobrinho ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Multiple Sclerosis ◽  
Facial Paralysis ◽  
Brain Magnetic Resonance Imaging ◽  
Oligoclonal Bands ◽  
Resonance Imaging ◽  
The Family ◽  
History Of ◽  
Magnetic Resonance Imaging Mri ◽  
Csf Oligoclonal Bands

The revision of MEDLINE from 1966 to 2003 did not report any association between multiple sclerosis (MS) and Melkersson—Rosenthal syndrome (MRS). This is a case report of a 51-year-old woman, with history of four recurrent Bell’s palsies. In 1999 she developed a right facial paralysis due to a supranuclear pyramidal lesion with right monoparesis. The family history showed five relatives with recurrent Bell’s paralysis and plicata tongue. Physical examination: right Bell’s paralysis, left supranuclear facial paralysis, furrowed tongue, right hemiparesis with pallor of the optic disks. Brain magnetic resonance imaging (MRI) demonstrated the typical lesions of MS and CSF oligoclonal bands. This is the first observation of a patient with hereditary MRS and MS. The link between both diseases is discussed.

scholarly journals Risk of Multiple Sclerosis after Idiopathic Optic Neuritis in a Pakistani Population

2010 ◽  
Vol 37 (2) ◽  
pp. 258-263 ◽  
Author(s):  
Syed Faraz Kazim ◽  
Muhammad Islam ◽  
Mustafa Khan ◽  
Bilal Hameed ◽  
Saad Shafqat
Keyword(s):  
Multiple Sclerosis ◽  
Optic Neuritis ◽  
Brain Mri ◽  
Brain Magnetic Resonance Imaging ◽  
Oligoclonal Bands ◽  
Cumulative Probability ◽  
South Asian Population ◽  
Increased Risk ◽  
Risk Of Progression ◽  
Csf Oligoclonal Bands

Background and objective:Optic neuritis (ON) is associated with a 38% ten-year risk of developing multiple sclerosis (MS) in Western populations, but the corresponding risk in non-Western populations is unclear. We conducted this study to estimate the risk of progression to MS after an episode of ON in a South Asian population.Methods:Two hundred and fifty-three patients with idiopathic ON were identified by reviewing records of visual evoked potentials and chart notes from a single academic center spanning the years 1990-2007. A structured telephone interview was then conducted to identify patients who had subsequently received a diagnosis of MS. The diagnosis was corroborated from chart notes, where possible. Cumulative probability of conversion to MS was calculated using Kaplan-Meier survival analysis.Results:The five-year risk of developing MS was 14.6% and the ten-year risk was 24%. Patients (N=218) who had one or more typical demyelinating lesions on baseline brain magnetic resonance imaging (MRI) had a 68% 10-year risk; those with no lesions or non-typical lesions had a 14% risk (p<0.001). Female gender, recurrent ON, and occurrence of ON in winter months were also associated with increased risk (p≤ 0.001). Severity of ON and likelihood of detecting cerebrospinal fluid (CSF) oligoclonal bands were higher in patients who developed MS.Conclusion:Idiopathic ON in Pakistan carries a lower risk of progression to MS compared with Western data. As in Western populations, however, presence of abnormal baseline brain MRI and CSF oligoclonal bands correlate with increased MS risk.

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 Safety and efficacy of helminth treatment in relapsing-remitting multiple sclerosis: Results of the HINT 2 clinical trial

2017 ◽  
Vol 25 (1) ◽  
pp. 81-91 ◽  
Author(s):  
John Fleming ◽  
Gianna Hernandez ◽  
Leslie Hartman ◽  
Jane Maksimovic ◽  
Sara Nace ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Brain Magnetic Resonance Imaging ◽  
Relapsing Remitting ◽  
Mri Scans ◽  
Remitting Multiple Sclerosis ◽  
Magnetic Resonance Imaging Mri ◽  
Disease Modifying Treatment ◽  
Relapsing Remitting Multiple Sclerosis ◽  
Regulatory Lymphocytes ◽  
Versus Treatment

Background: The hygiene hypothesis suggests that microbial replacement may be therapeutic in allergic and autoimmune diseases. Nevertheless, the results of helminth treatment, including in multiple sclerosis (MS), have been inconclusive. Objective: To assess safety and brain magnetic resonance imaging (MRI) activity in subjects with relapsing-remitting multiple sclerosis (RRMS) during oral administration of ova from the porcine whipworm, Trichuris suis (TSO). Methods: A total of 16 disease-modifying treatment (DMT) naive RRMS subjects were studied in a baseline versus treatment (BVT) controlled prospective study. MRI scans were performed during 5 months of screening-observation, 10 months of treatment, and 4 months of post-treatment surveillance. Results: No serious symptoms or adverse events occurred during treatment. For the cohort, there was a trend consistent with a 35% diminution in active lesions when observation MRIs were compared to treatment MRIs ( p = 0.08), and at the level of individuals, 12 of 16 subjects improved during TSO treatment. T regulatory lymphocytes were increased during TSO treatment. Conclusion: TSO is safe in RRMS subjects. Potentially favorable MRI outcomes and immunoregulatory changes were observed during TSO treatment; however, the magnitude of these effects was modest, and there was considerable variation among the responses of individual subjects.

Oral contraceptives do not modify the risk of a second attack and disability accrual in a prospective cohort of women with a clinically isolated syndrome and early multiple sclerosis

2021 ◽  
pp. 135245852110530
Author(s):  
Susana Otero-Romero ◽  
Pere Carbonell-Mirabent ◽  
Luciana Midaglia ◽  
María Zuluaga ◽  
Ingrid Galán ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Prospective Cohort ◽  
Cox Regression ◽  
Clinically Isolated Syndrome ◽  
Sensitivity Analyses ◽  
Oligoclonal Bands ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
T2 Lesions ◽  
Disease Modifying Treatment

Objective: To evaluate whether oral contraceptive (OC) use is associated with the risk of a second attack and disability accrual in women with a clinically isolated syndrome (CIS) and early multiple sclerosis (MS). Methods: Reproductive information from women included in the Barcelona CIS prospective cohort was collected through a self-reported cross-sectional survey. We examined the relationship of OC exposure with the risk of a second attack and confirmed Expanded Disability Status Scale of 3.0 using multivariate Cox regression models, adjusted by age, topography of CIS, oligoclonal bands, baseline brain T2 lesions, body size at menarche, smoking, and disease-modifying treatment (DMT). OC and DMT exposures were considered as time-varying variables. Findings were confirmed with sensitivity analyses using propensity score models. Results: A total of 495 women were included, 389 (78.6%) referred to ever use OC and 341 (68.9%) started OC before the CIS. Exposure to OC was not associated with a second attack (adjusted hazard ratio (aHR) = 0.73, 95% confidence interval (CI) = 0.33–1.61) or disability accrual (aHR = 0.81, 95% CI = 0.17–3.76). Sensitivity analyses confirmed these results. Conclusion: OC use does not modify the risk of second attack or disability accrual in patients with CIS and early MS, once considered as a time-dependent exposure and adjusted by other potential confounders.

scholarly journals One-and-a-half Syndrome Associated with Multiple Sclerosis in a 14-year-old Girl

2021 ◽  
Vol 62 (8) ◽  
pp. 1155-1159
Author(s):  
Yeon Ju Lim ◽  
Soo Jung Lee
Keyword(s):  
Multiple Sclerosis ◽  
Brain Magnetic Resonance Imaging ◽  
Underlying Disease ◽  
Oligoclonal Bands ◽  
Cerebral White Matter ◽  
Fluid Attenuated Inversion Recovery ◽  
Poor Outcomes ◽  
Intravenous Steroids ◽  
The Right ◽  
Mild Headache

Purpose: To report the case of a 14-year-old female patient with one-and-a-half syndrome subsequently diagnosed with multiple sclerosis involving the pons.Case summary: A 14-year-old girl without any underlying disease presented with difficulty focusing and mild headache for 5 days. The patient showed conjugate gaze palsy to the left, limited adduction in the left eye, and abducting nystagmus in the right eye, which indicated one-and-half syndrome. T2 fluid-attenuated inversion recovery brain magnetic resonance imaging revealed multiple punctate hyperintensities in the pontine tegmentum, bilateral cerebral white matter, and cerebellum. Cerebrospinal fluid examination revealed oligoclonal bands and multiple sclerosis was diagnosed. The patient was treated with intravenous steroids and beta-interferon. Seven weeks later, limitation of eyeball movement and nystagmus had resolved completely.Conclusions: At the young age of 14 years, a patient presenting with one-and-a-half syndrome was diagnosed with multiple sclerosis. Children with multiple sclerosis may experience severe physical and cognitive impairments, and brainstem involvement predicts an especially poor prognosis. Early diagnosis and active treatment may help to prevent poor outcomes.

Sign in / Sign up

Export Citation Format

Share Document