scholarly journals Association of asymptomatic spinal cord lesions and atrophy with disability 5 years after a clinically isolated syndrome

2016 ◽  
Vol 23 (5) ◽  
pp. 665-674 ◽  
Author(s):  
WJ Brownlee ◽  
DR Altmann ◽  
P Alves Da Mota ◽  
JK Swanton ◽  
KA Miszkiel ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Brain Atrophy ◽  
Brain Magnetic Resonance Imaging ◽  
Clinically Isolated Syndrome ◽  
Cervical Cord ◽  
Spinal Cord Lesions ◽  
Spinal Cord Atrophy ◽  
Lesion Number ◽  
Cord Lesion

Background: Spinal cord pathology is an important substrate for long-term disability in multiple sclerosis (MS). Objective: To investigate longitudinal changes in spinal cord lesions and atrophy in patients with a non-spinal clinically isolated syndrome (CIS), and how they relate to the development of disability. Methods: In all, 131 patients with a non-spinal CIS had brain and spinal cord imaging at the time of CIS and approximately 5 years later (median: 5.2 years, range: 3.0–7.9 years). Brain magnetic resonance imaging (MRI) measures consisted of T2-hyperintense and T1-hypointense lesion loads plus brain atrophy. Spinal cord MRI measures consisted of lesion number and the upper cervical cord cross-sectional area (UCCA). Disability was measured using the Expanded Disability Status Scale (EDSS). Multiple linear regression was used to identify independent predictors of disability after 5 years. Results: During follow-up, 93 (71%) patients were diagnosed with MS. Baseline spinal cord lesion number, change in cord lesion number and change in UCCA were independently associated with EDSS ( R2 = 0.53) at follow-up. Including brain T2 lesion load and brain atrophy only modestly increased the predictive power of the model ( R2 = 0.64). Conclusion: Asymptomatic spinal cord lesions and spinal cord atrophy contribute to the development of MS-related disability over the first 5 years after a non-spinal CIS.

Atrophy and structural variability of the upper cervical cord in early multiple sclerosis

2014 ◽  
Vol 21 (7) ◽  
pp. 875-884 ◽  
Author(s):  
Viola Biberacher ◽  
Christine C Boucard ◽  
Paul Schmidt ◽  
Christina Engl ◽  
Dorothea Buck ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Spinal Cord ◽  
Brain Magnetic Resonance Imaging ◽  
Cervical Cord ◽  
Focal Lesions ◽  
Spinal Cord Atrophy ◽  
Cross Sectional ◽  
Structural Variability ◽  
Upper Cervical ◽  
In Cis

Background: Despite agreement about spinal cord atrophy in progressive forms of multiple sclerosis (MS), data on clinically isolated syndrome (CIS) and relapsing–remitting MS (RRMS) are conflicting. Objective: To determine the onset of spinal cord atrophy in the disease course of MS. Methods: Structural brain magnetic resonance imaging (MRI) was acquired from 267 patients with CIS (85) or RRMS (182) and 64 healthy controls (HCs). The upper cervical cord cross-sectional area (UCCA) was determined at the level of C2/C3 by a segmentation tool and adjusted for focal MS lesions. The coefficient of variation (CV) was calculated from all measurements between C2/C3 and 13 mm above as a measure of structural variability. Results: Compared to HCs (76.1±6.9 mm2), UCCA was significantly reduced in CIS patients (73.5±5.8 mm2, p=0.018) and RRMS patients (72.4±7.0 mm2, p<0.001). Structural variability was higher in patients than in HCs, particularly but not exclusively in case of focal lesions (mean CV HCs/patients without/with lesions: 2.13%/2.55%/3.32%, all p-values<0.007). UCCA and CV correlated with Expanded Disability Status Scale (EDSS) scores ( r =−0.131/0.192, p=0.044/<0.001) and disease duration ( r=−0.134/0.300, p=0.039/< 0.001). CV additionally correlated with hand and arm function ( r=0.180, p=0.014). Conclusion: In MS, cervical cord atrophy already occurs in CIS. In early stages, structural variability may be a more meaningful marker of spinal cord pathology than atrophy.

Mean upper cervical cord area (MUCCA) measurement in long-standing multiple sclerosis: Relation to brain findings and clinical disability

2014 ◽  
Vol 20 (14) ◽  
pp. 1860-1865 ◽  
Author(s):  
Marita Daams ◽  
Florian Weiler ◽  
Martijn D Steenwijk ◽  
Horst K Hahn ◽  
Jeroen JG Geurts ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Spinal Cord ◽  
Brain Magnetic Resonance Imaging ◽  
Cervical Cord ◽  
Healthy Controls ◽  
Spinal Cord Atrophy ◽  
Disability Status ◽  
Upper Cervical ◽  
Male Patients ◽  
Magnetic Resonance Imaging Mri

Background: The majority of patients with multiple sclerosis (MS) present with spinal cord pathology. Spinal cord atrophy is thought to be a marker of disease severity, but in long-disease duration its relation to brain pathology and clinical disability is largely unknown. Objective: Our aim was to investigate mean upper cervical cord area (MUCCA) in patients with long-standing MS and assess its relation to brain magnetic resonance imaging (MRI) measures and clinical disability. Methods: MUCCA was measured in 196 MS patients and 55 healthy controls using 3DT1-weighted cervical images obtained at 3T MRI. Clinical disability was measured using the Expanded Disability Status Scale (EDSS), Nine-Hole-Peg test (9-HPT), and 25 feet Timed Walk Test (TWT). Stepwise linear regression was performed to assess the association between MUCCA and MRI measures, and between MUCCA and clinical disability. Results: MUCCA was smaller (mean 11.7%) in MS patients compared with healthy controls (72.56±9.82 and 82.24±7.80 mm2 respectively; p<0.001), most prominently in male patients. MUCCA was associated with normalized brain volume, and number of cervical cord lesions. MUCCA was independently associated with EDSS, TWT, and 9-HPT. Conclusion: MUCCA was reduced in MS patients compared with healthy controls. It provides a relevant marker for clinical disability in long-standing disease, independent of other MRI measures.

scholarly journals Elevated CSF neurofilament proteins predict brain atrophy: A 15-year follow-up study

2016 ◽  
Vol 22 (9) ◽  
pp. 1154-1162 ◽  
Author(s):  
Axel Petzold ◽  
Martijn D Steenwijk ◽  
Judith M Eikelenboom ◽  
Mike P Wattjes ◽  
Bernard MJ Uitdehaag
Keyword(s):  
Multiple Sclerosis ◽  
Spinal Cord ◽  
Brain Atrophy ◽  
Imaging Biomarkers ◽  
Grey Matter Volume ◽  
Structural Imaging ◽  
Spinal Cord Atrophy ◽  
Protein Levels ◽  
Specific Calculations

Background: Body fluid and structural imaging biomarkers give information on neurodegeneration. The relationship over time is not known in multiple sclerosis. Objective: To investigate the temporal relationship of elevated cerebrospinal fluid (CSF) neurofilament (Nf) protein levels, a biomarker for axonal loss, with magnetic resonance imaging (MRI) atrophy measures. Methods: In patients with multiple sclerosis, CSF Nf heavy chain (NfH) phosphoform levels were quantified at baseline and dichotomised into ‘normal’ and ‘high’. Atrophy was assessed by MRI at baseline and 15-year follow-up using SIENAX and FreeSurfer software. Results: High baseline CSF NfH SMI35 levels predicted pronounced atrophy at 15-year follow-up (odds ratio (OR): 36, p < 0.01), in the absence of baseline brain atrophy (OR: 28, p < 0.05), for the averaged MRI normalised brain volume (1.44 L vs 1.33 L, p < 0.05), normalised grey matter volume (0.77 L vs 0.69 L, p < 0.01) and putamen (12.7 mL vs 10.7 mL, p < 0.05). Region-specific calculations including the spinal cord showed that a power of >80% is reached with 14–50 patients. Conclusion: These data suggest that high CSF NfH levels are an early predictor of later brain and spinal cord atrophy using structural imaging biomarkers and can be investigated in reasonably sized patient cohorts.

Factors Affecting Functional Outcome in Patients with Nontraumatic Spinal Cord Lesions After Inpatient Rehabilitation

2001 ◽  
Vol 15 (2) ◽  
pp. 99-104 ◽  
Author(s):  
J.J.M.F. van der Putten ◽  
V.L. Stevenson ◽  
E.D. Playford ◽  
A.J. Thompson
Keyword(s):  
Spinal Cord ◽  
Regression Analysis ◽  
Prognostic Factors ◽  
Functional Outcome ◽  
Symptom Onset ◽  
Spinal Cord Lesion ◽  
Functional Improvement ◽  
Motor Score ◽  
Spinal Cord Lesions ◽  
Cord Lesion

Objective: Patients with nontraumatic spinal cord lesions account for between one fourth and one half of all spinal cord injuries. In the management of this group of patients, an understanding of factors influencing functional improvement is essen tial to help define the most appropriate rehabilitation programme. Although it is pos sible to predict accurately the functional outcome for an individual patient with a com plete traumatic spinal cord injury, few studies have looked at prognostic factors in patients with nontraumatic spinal cord disease. The aim of this study was to determine which, and how well, factors assessed on admission to a rehabilitation unit relate to functional improvement in this group. Methods: The study sample consists of 100 patients with an incomplete nontraumatic spinal cord lesion who underwent inpatient neurorehabilitation. Possible prognostic factors were sought by identifying those vari ables with a significant difference in the Functional Independence Measure (FIM) motor change score above and below the median. A step-wise multiple regression analysis was then performed to determine which variables influenced functional out come. Results: Patients with larger functional gains had significantly lower disability scores on admission, a shorter time between symptom onset and rehabilitation, and a longer length of stay. They were more likely to have a cervical lesion and evidence of neurologic recovery. Multiple regression analysis demonstrated that the FIM motor score on admission and the time between symptom onset and rehabilitation predicted 54% of the variance of the FIM motor score gain. Conclusions: This finding suggests that early rehabilitation is an important factor in securing a good outcome. Key Words: Rehabilitation-Spinal cord lesion-Functional outcome.

Spinal cord lesions in patients with clinically isolated syndrome: A powerful tool in diagnosis and prognosis

Neurology ◽  
2012 ◽  
Vol 80 (1) ◽  
pp. 69-75 ◽  
Author(s):  
M. H. Sombekke ◽  
M. P. Wattjes ◽  
L. J. Balk ◽  
J. M. Nielsen ◽  
H. Vrenken ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Clinically Isolated Syndrome ◽  
Spinal Cord Lesions ◽  
Diagnosis And Prognosis

The role of cerebellar abnormalities in neuromyelitis optica – a comparison with multiple sclerosis and healthy controls

2014 ◽  
Vol 21 (6) ◽  
pp. 757-766 ◽  
Author(s):  
Katrin Weier ◽  
Arman Eshaghi ◽  
Stefano Magon ◽  
Michaela Andelova ◽  
Ernst-Wilhelm Radue ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Spinal Cord ◽  
Neuromyelitis Optica ◽  
Brain Magnetic Resonance Imaging ◽  
Cervical Cord ◽  
Healthy Controls ◽  
Brain Volumes ◽  
Secondary Degeneration ◽  
Cerebellar Volume ◽  
And Gender

Background: In relapsing–remitting multiple sclerosis (RRMS), the cerebellum is a known predilection site for atrophy. Neuromyelitis optica (NMO) is characterized by extensive lesions in the spinal cord and optic nerve; however, cerebellar involvement has been less studied. Secondary degeneration of the spinocerebellar tract could impact the cerebellum in NMO. Objective: We aimed to investigate whether spinal cord and cerebellar volume measures differ between patients with NMO and RRMS. Methods: Volumetric analyses of the cerebellum (TCV), the upper cervical cord (UCV) as well as the whole brain (NBV) of age- and gender-matched patients with NMO ( n=30; 56% AQP4 +ve) and RRMS ( n=25) were performed on 3T brain magnetic resonance imaging (MRI) and compared with 34 healthy controls (HC). Results: UCV was significantly reduced in NMO patients (6.3 cm3) as compared with HC (6.7 cm3), while patients with MS had reduced brain volumes compared with HC (NBV=1482 cm3; p<0.001; TCV=188 cm3; p=0.042), but UCV close to normal values. Patients with RRMS and NMO differed in NBV ( p=0.001; lower in RRMS) and by trend (towards reduction in RRMS) in cerebellar volume ( p=0.06). Conclusions: While atrophy seems to be diffuse in MS patients, a rather focussed pattern with predominant involvement of the UCV was observed in NMO patients.

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 Intradural Arteriovenous Fistulae: Anatomic, Clinical, and Therapeutic Considerations in a Series of 32 Consecutive Patients Seen between 1981 and 2000 with Emphasis on Endovascular Therapy

Neurosurgery ◽  
2005 ◽  
Vol 57 (5) ◽  
pp. 973-983 ◽  
Author(s):  
Georges Rodesch ◽  
Michel Hurth ◽  
Hortensia Alvarez ◽  
Marc Tadie ◽  
Pierre Lasjaunias
Keyword(s):  
Spinal Cord ◽  
Adult Population ◽  
Clinical Status ◽  
Clinical Results ◽  
Cervical Cord ◽  
Karnofsky Performance Scale ◽  
Presenting Symptoms ◽  
Arteriovenous Shunts ◽  
Thoracolumbar Region

Abstract OBJECTIVE: To review our series of intradural spinal cord arteriovenous fistulas (SCAVFs), analyzing symptoms and related angioarchitecture, and to study the morphological and clinical results of embolization. METHODS: Thirty-two SCAVFs (in 22 adults and 10 children) were treated between 1981 and 2000. These lesions were classified as microarteriovenous fistulas (mAVFs) or macroarteriovenous fistulas (MAVFs) according to shunt morphology. Location, architecture, presenting symptoms, and age group were detailed. The selection of patients for endovascular versus surgical treatments was analyzed, as were the anatomic and clinical results obtained by embolization with n-butylcyanoacrylate. Clinical status was evaluated according to the Karnofsky Performance Scale score. RESULTS: Ten SCAVFs were found in the pediatric population (four mAVFs and six MAVFs). All four mAVFs presented with acute symptoms. Three mAVFs (two cervical and one thoracic) presented hematomyelia; in one patient with a thoracic AVF, subarachnoid hemorrhage was suspected. All six MAVFs were located in the thoracolumbar cord (five associated with hereditary hemorrhagic telangiectasias). Four of the six MAVFs presented with hemorrhage. In the adult population, there were 21 mAVFS (95%) and one MAVF (5%). Only two mAVFs were found in the cervical cord, all other shunts affecting the thoracolumbar region. Hemorrhage was present in 6 of the 22 cases seen in adults (27%). The symptoms of SCAVFs did not differ from those found in spinal cord arteriovenous shunts of nidus type. Pial venous reflux and congestion were the most frequently encountered features in both the adult and pediatric groups. Arterial aneurysms (different from false aneurysms) were not found in association with hemorrhagic presentation of SCAVFs. Mean follow-up in our series was 3.3 years. Of the MAVFs, 86% were embolized, with 67% cured. The others had more than 75% occlusion. All patients followed up improved significantly. Of the mAVFs, 48% were treated endovascularly. Successful embolization was performed in 75% of patients. One patient was not embolized because of vasospasm, whereas 67% percent of mAVFs were completely occluded, 22% were more than 90% occluded, and 11% were 75% occluded. Complementary surgery was deemed unnecessary. All patients with mAVFs improved significantly at follow-up. Transient complications occurred in 22% of all patients, with no permanent morbidity or mortality. No patient bled or rebled after embolization. Thirty-six percent of mAVFs were operated on because of anticipated technical difficulties for endovascular approach or distal localization of the shunt. CONCLUSION: Endovascular treatment of SCAVFs stabilizes, normalizes, or improves neurological symptoms in all patients at long-term follow-up, with no bleeds or rebleeds. Embolization of SCAVFs with glue is a safe treatment that compares favorably with other approaches and significantly improves the poor natural history of the disease.

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.

La RM nelle sequele dei traumi spinali

1997 ◽  
Vol 10 (2_suppl) ◽  
pp. 192-195 ◽  
Author(s):  
G. Pellicanò ◽  
G. Caracchini ◽  
M. D'Andrea ◽  
M. Bartolucci ◽  
I. Del Seppia ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Surgical Treatment ◽  
Acute Phase ◽  
Vertebral Body ◽  
Neurological Symptoms ◽  
Spinal Cord Lesions ◽  
Guided Surgery ◽  
Thoracic Level ◽  
Post Traumatic

From January 1990 to April 1997 we retrospectively evaluated 90 patients with MR examinations at our Spine Unit. The following post-traumatic spinal cord lesions were diagnosed: atrophy (47 pts), myelomalacia (40 pts), cysts (14), syrinx (14) and medullary transection with adhesion(4 pts). MR was very useful to identify atrophy more frequently found at the cervical-thoracic level (C6-D3). Myelomalcia was found in a patient with severe vertebral body trauma with chronic compression of the spinal cord. Intramedullary cysts were found in patients with hematomyelia in acute phase and were stable lesions. Post-traumatic syringomyelia is the most important sequela due to the fact that is often correlated with symptoms. MR not only detected the lesion but also identified intramedullary cavities without new neurological symptoms and guided surgery and follow-up. MR is the examination of choice not only for diagnosis of chronic spinal cord lesions but also to evaluate the possibility of surgical treatment.

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