Spinal cord lesions: A modest contributor to diagnosis in clinically isolated syndromes but a relevant prognostic factor

Background: The usefulness of performing a spinal cord (SC) magnetic resonance imaging (MRI) in all clinically isolated syndromes (CIS) is controversial. Objective: To assess the value of SC lesions for predicting multiple sclerosis (MS) diagnosis and disability accrual in CIS. Methods: Concerning SC lesions and MS diagnosis (2010 McDonald), adjusted Cox regression analyses were performed in increasingly specific CIS groups: all cases ( n = 207), non-SC CIS ( n = 143), non-SC CIS with abnormal brain MRI ( n = 90) and non-SC CIS with abnormal brain MRI not fulfilling 2010 MS ( n = 67). For the outcome Expanded Disability Status Scale (EDSS) ≥3.0, similar analyses were performed in all cases ( n = 207), non-SC CIS ( n = 143) and SC CIS ( n = 64). Performance at 2 years was assessed for all outcomes. Results: The presence of SC lesions increased MS risk 2.0–2.6 times independently of factors like brain lesions. If considering lesion number, the risk ranged from 1.6 to 2.1 for one lesion to 2.4–3.3 for ≥2. SC lesions increased the short-term disability risk around fivefold, better demonstrated in non-SC CIS. SC lesions were very specific for evolution to MS and showed very high sensitivity for EDSS ≥3.0. Conclusion: SC lesions are independent predictors of MS in all CIS and contribute to short-term disability accrual. SC MRIs in CIS could be useful to estimate their prognosis.

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Leber’s hereditary optic neuropathy associated with a multiple-sclerosis-like picture in a man

Multiple Sclerosis Journal ◽

10.1177/1352458511404033 ◽

2011 ◽

Vol 17 (6) ◽

pp. 763-766 ◽

Cited By ~ 10

Author(s):

Antonella La Russa ◽

Rita Cittadella ◽

Virginia Andreoli ◽

Paola Valentino ◽

Francesca Trecroci ◽

...

Keyword(s):

Multiple Sclerosis ◽

Spinal Cord ◽

Optic Neuropathy ◽

Brain Mri ◽

Resonance Imaging ◽

Gadolinium Enhancement ◽

Demyelinating Lesions ◽

Male Patients ◽

Magnetic Resonance Imaging Mri ◽

Symptoms And Signs

A 35-year-old young man displayed Leber’s optic neuropathy (LHON) due to T14484C and multiple sclerosis (MS) phenotype that was dominated by symptoms and signs of spinal cord impairment. Magnetic resonance imaging (MRI) revealed demyelinating lesions extending from D6 to D11 in the spinal cord with gadolinium enhancement, while only three linear demyelinating lesions were seen on brain MRI. In the literature, a major involvement of the spinal cord was already reported in three of four male patients with the 14484 LHON mutation who developed MS, but the reasons of this peculiar association remain unknown, and further research in this area is needed.

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Evaluation of Brain Magnetic Resonance Imaging (MRI) Findings of Neonates with Clinical Seizure Admitted to Yazd Shahid Sadoughi Hospital and its Effect on Diagnostic and Therapeutic Interventions of Newborns from 2015-2016

Journal of Shahid Sadoughi University of Medical Sciences ◽

10.18502/ssu.v28i9.4777 ◽

2020 ◽

Author(s):

Razieh Fallah ◽

Mohammad Javad Asadi ◽

Reza Nafisi Moghadam ◽

Mohammad Hossein Ahrar Yazdi

Keyword(s):

Magnetic Resonance Imaging ◽

Brain Mri ◽

Brain Magnetic Resonance Imaging ◽

Common Type ◽

Therapeutic Interventions ◽

Resonance Imaging ◽

Mri Findings ◽

Clinical Seizure ◽

Magnetic Resonance Imaging Mri ◽

Abnormal Brain

Introduction: In neonatal period, brain magnetic resonance imaging (MRI) is the best neuroimaging to find etiology of seizure. The aim of this study was to evaluate brain MRI findings of neonates with clinical seizure and its effect on diagnostic and therapeutic interventions of newborn. Methods: In a retrospective study, medical records and brain MRI findings of neonates with clinical seizure admitted to Neonatal Intensive Care Unit or Pediatric Ward of Shahid Sadoughi Hospital, Yazd, Iran from September 2018 and before were evaluated. The data were analyzed using SPSS version 16 software , the required indicators and tables were prepared and Fisher exact test and Chi-square test were used to determine the relationship between qualitative variables and independent t-test was used to compare the means in the two groups Results: Twenty-five girls and 38 boys were studied. The cause of seizures was found in 94% and the most common cause of congenital hypoxia was in 22 infants (35%). The most common type of seizure was tonic in 23 infants (36.5%) and the most common type of generalized seizure was in 47 infants (75%). Brain MRI was abnormal in 19 neonates (30%). Based on the MRI results, there was a change in therapeutic interventions (brain surgery) in four infants (6.3%) and in diagnostic interventions (metabolic tests) in 19 infants (30%). Abnormal brain MRI was more frequent in neonates by cesarean section (46%) than normal vaginal delivery (19%), (p= 0.01) and also neonates with partial seizure (37.5%) had an abnormal MRI than generalized seizure (21%), (p= 0.03). Mean of hospitalization days was longer in neonates with abnormal brain MRI (12.32±2.76 days) than neonates with normal MRI (8.57±2.82 days) (P = 0.02). Conclusion: Based on the results of this study, brain MRI might be useful in finding intracranial pathology that causes seizure in neonates by cesarean section to detect birth asphyxia and in newborns with partial seizure.

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Asymptomatic spinal cord lesions do not predict the time to disability in patients with early multiple sclerosis

Multiple Sclerosis Journal ◽

10.1177/1352458517736147 ◽

2017 ◽

Vol 24 (4) ◽

pp. 481-490 ◽

Cited By ~ 11

Author(s):

Iris Dekker ◽

Madeleine H Sombekke ◽

Birgit I Witte ◽

Jeroen JG Geurts ◽

Frederik Barkhof ◽

...

Keyword(s):

Multiple Sclerosis ◽

Spinal Cord ◽

Demographic Data ◽

Disability Progression ◽

Definite Multiple Sclerosis ◽

Relapsing Remitting ◽

Clinically Definite Multiple Sclerosis ◽

Magnetic Resonance Imaging Mri ◽

Relapsing Remitting Multiple Sclerosis ◽

In Cis

Background: The presence of asymptomatic spinal cord (SC) lesions in patients with clinically isolated syndrome (CIS) or relapsing-remitting multiple sclerosis (RRMS) predicts conversion to clinically definite multiple sclerosis (CDMS). The relation between asymptomatic SC abnormalities and disability progression warrants further investigation. Objective: To determine the prognostic value of asymptomatic SC lesions in CIS and early RRMS with respect to the time to disability development. Methods: Clinical and demographic data, brain and SC magnetic resonance imaging (MRI) were collected of CIS or early RRMS patients. Two main analyses were performed. For the first analysis, patients were divided into two groups: (1) patients with asymptomatic SC lesions and (2) patients without SC lesions and patients with symptomatic SC lesions. The second analysis excluded patients with symptomatic SC lesions. Incidence curves were used to analyse differences between these groups in time to the development of disability and time to a second relapse. Results: A total of 178 patients were included, and 42 patients (23.6%) had asymptomatic SC lesions. No significant differences were found on the time to disability development or the time to a second event. Conclusion: Asymptomatic SC lesions early in the disease course do not predict the time to disability development in patients diagnosed with CIS or early RRMS.

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Deep gray matter T2 hypointensity is present in patients with clinically isolated syndromes suggestive of multiple sclerosis

Multiple Sclerosis Journal ◽

10.1177/1352458509350310 ◽

2009 ◽

Vol 16 (1) ◽

pp. 39-44 ◽

Cited By ~ 44

Author(s):

Antonia Ceccarelli ◽

Maria A Rocca ◽

Mohit Neema ◽

Vittorio Martinelli ◽

Ashish Arora ◽

...

Keyword(s):

Multiple Sclerosis ◽

Caudate Nucleus ◽

Gray Matter ◽

Lesion Volume ◽

Clinically Isolated Syndromes ◽

Increased Risk ◽

Left Caudate ◽

Magnetic Resonance Imaging Mri ◽

Putative Marker ◽

In Cis

Gray matter (GM) magnetic resonance imaging (MRI) T2 hypointensity, a putative marker of iron deposition, is a frequent finding in patients with clinically definite (CD) multiple sclerosis (MS). The objective of this study was to assess: (a) how early deep GM T2 hypointensity occurs in MS, by studying patients with clinically isolated syndromes (CIS) suggestive of MS, and (b) whether they contribute to predict subsequent evolution to CDMS. Dual-echo scans using two different acquisition protocols were acquired from 47 CIS patients and 13 healthy controls (HC). Normalized T2-intensity of the basal ganglia and thalamus was quantified. Patients were assessed clinically at the time of MRI acquisition and after three years. During the observation period, 18 patients (38%) evolved to CDMS. At the baseline, only the GM T2-intensity of the left caudate nucleus was significantly reduced in CIS patients in comparison with the HC (p = 0.04). At the baseline, the T2 intensity of the left caudate nucleus was significantly lower (p = 0.01) in CIS patients with disease dissemination in space (DIS), but not in those without DIS, compared to the HC. The baseline T2 lesion volume, but not GM T2 hypointensity, was associated with evolution to CDMS (hazard ratio = 1.60, 95% confidence interval (CI) = 1.05—2.42; p = 0.02). In CIS patients, deep GM is not spared, suggesting that iron-related changes and neurodegeneration occurs early. The magnitude of such damage is only minor and not associated with an increased risk of evolution to CDMS.

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Prognostic value of cerebrospinal fluid analysis at the time of a first demyelinating event

Multiple Sclerosis Journal ◽

10.1177/1352458510385506 ◽

2010 ◽

Vol 17 (2) ◽

pp. 164-172 ◽

Cited By ~ 12

Author(s):

Olivier Gout ◽

Annie Bouchareine ◽

Antoine Moulignier ◽

Romain Deschamps ◽

Caroline Papeix ◽

...

Keyword(s):

Cerebrospinal Fluid ◽

Cox Model ◽

Brain Mri ◽

Age At Onset ◽

Short Term ◽

Fluid Analysis ◽

Definite Multiple Sclerosis ◽

Magnetic Resonance Imaging Mri ◽

Csf Findings

Background and Objective: This study aimed to assess the value of cerebrospinal fluid (CSF) findings for predicting conversion to clinically definite multiple sclerosis (CDMS). Methods: From a database of 447 patients with a first demyelinating event, the records of 208 patients less than 51 years old who had baseline magnetic resonance imaging (MRI) and CSF examinations and a follow-up of at least 1 year were included. A multivariable Cox model was used to assess the short-term risk of CDMS according to baseline CSF findings after adjustment for prognostic factors (including brain MRI) and to provide a simple classification for predicting CDMS. Results: During a median follow-up of 3.5 years, 141 (67.8%) patients converted to CDMS. In multivariate analysis, younger age (hazard ratio [HR]: 1.44 [95% CI 1.02–2.01]), spatial dissemination on brain MRI (HR: 2.07 [95% CI 1.47–2.91]) and more than 4 WBC/mm3 in CSF (HR: 1.44 [95% CI 1.03–2.02]) were independently associated with CDMS. The Cox score obtained from these three predictors enabled patients to be divided into three groups with significant increased risks of CDMS at 1, 2 and 3 years; groups were classified as high-risk (64.7%, 77.4%, 96.1%), intermediate-risk (33.3%, 51.5%, 61.5%), and low-risk (11.1%, 18.3%, 40.3%). Conclusions: Age at onset, spatial dissemination on brain MRI and CSF white blood cell count are independently associated with short-term conversion to CDMS. The three proposed risk group classifications could be a useful tool to select patients for early therapeutic intervention.

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Neuromyelitis optica: brain abnormalities in a Brazilian cohort

Arquivos de Neuro-Psiquiatria ◽

10.1590/s0004-282x2008000100001 ◽

2008 ◽

Vol 66 (1) ◽

pp. 1-4 ◽

Cited By ~ 21

Author(s):

Denis Bernardi Bichuetti ◽

René Leandro Magalhães Rivero ◽

Daniel May Oliveira ◽

Nilton Amorin de Souza ◽

Nitamar Abdala ◽

...

Keyword(s):

Neuromyelitis Optica ◽

Demyelinating Disease ◽

Brain Mri ◽

Brain Magnetic Resonance Imaging ◽

Resonance Imaging ◽

Radiological Features ◽

Relapsing Remitting ◽

Magnetic Resonance Imaging Mri ◽

Brazilian Cohort ◽

Abnormal Brain

Neuromyelitis optica (NMO) is a demyelinating disease consisting of relapsing-remitting optic neuritis and myelitis with a more severe course than Multiple Sclerosis. Recently, it has been shown that almost 50% of patients with NMO can have brain magnetic resonance imaging (MRI) abnormalities. We report on six Brazilian patients with NMO, fulfilling the 1999 Wingerchuck criteria for this disease, with abnormal brain MRI and discuss their clinical and radiological features.

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Predictors of short-term disease activity following a first clinical demyelinating event: analysis of the CHAMPS placebo groupy

Multiple Sclerosis Journal ◽

10.1191/1352458502ms825oa ◽

2002 ◽

Vol 8 (5) ◽

pp. 405-409 ◽

Cited By ~ 8

Author(s):

Keyword(s):

Disease Activity ◽

Brain Mri ◽

Brain Magnetic Resonance Imaging ◽

Event Analysis ◽

Short Term ◽

T2 Lesions ◽

Disease Modifying Therapy ◽

Increased Risk ◽

Definite Multiple Sclerosis ◽

Magnetic Resonance Imaging Mri

We evaluated 190 patients in the placebo group of the CHAMPS trial in order to assess factors associated with short-term clinical and brain magnetic resonance imaging (MRI) outcomes in patients with a first clinical demyelinating event involving the optic nerve, spinal cord, or brainstem/cerebellum, and subclinical demyelination on brain MRI. The two study outcomes were 1) development of clinically definite multiple sclerosis (CDMS) and 2) development of CDMS or two or more new or enlarging brain MRI T2 lesions. The presence of gadolinium (Gd)- enhancing lesions on the baseline scan was the only MRI characteristic associated with a higher risk of both the clinical and combined outcomes (p=0.003 and <0.001, respectively). The only demographic or clinical characteristic associated with an increased risk of these outcomes was younger age (p<0.001 for both outcomes). The lowest risk subgroups we could define had a 30% risk of CDMS and a 65% risk of the combined clinical/MRI outcome. Our results indicate that all patients presenting with a first demyelinating event who also have brain MRI evidence of subclinical demyelination have at least a moderate risk of short-term disease activity. This finding provides support for initiating disease-modifying therapy at the time of the first demyelinating event in patients meeting the CHAMPS enrollment criteria.

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Polyregional and hemispheric syndromes: a study of these uncommon first attacks in a CIS cohort

Multiple Sclerosis Journal ◽

10.1177/1352458506074178 ◽

2007 ◽

Vol 13 (6) ◽

pp. 731-736 ◽

Cited By ~ 4

Author(s):

R. Pelayo ◽

M. Tintoré ◽

A. Rovira ◽

J. Rio ◽

C. Nos ◽

...

Keyword(s):

Magnetic Resonance Imaging ◽

Multiple Sclerosis ◽

Spinal Cord ◽

Clinical Symptoms ◽

Brain Mri ◽

Resonance Imaging ◽

Number Of Patients ◽

Cns Demyelination ◽

Magnetic Resonance Imaging Mri ◽

Definition Of

Clinically isolated syndromes (CIS) classically refer to optic neuritis (ON), brainstem or spinal cord syndromes. Less common first episodes suggestive of central nervous system (CNS) demyelination, such as hemispheric or clinically polyregional syndromes, have been only slightly studied. The aim of this study was to describe these CIS topographies in our cohort of patient with a CIS. We evaluated 320 patients with a CIS, and classified the topographies of the attacks according to clinical symptoms only into CIS of the optic nerve (123), brainstem (78), spinal cord (89), hemispheric (6), polyregional (12) or undetermined (12) topographies. Patients underwent brain MRI within three months of their first attack, and again 12 months later. Conversion to multiple sclerosis (MS), determined either clinically or by magnetic resonance imaging (MRI), was evaluated according to topography. Hemispheric and polyregional syndromes were closer to brainstem or spinal cord syndromes than ON in clinical and MRI conversion terms, although a statistical analysis was not performed because of the small number of patients. There are differences between several studies in the definition, and, therefore, the prevalence of these so-called atypical CIS. Consensus on the denomination and definition of these syndromes must be reached. Multiple Sclerosis 2007; 13: 731-736. http://msj.sagepub.com

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Postoperative cerebral air embolism with delayed abnormal brain MRI findings

eNeurologicalSci ◽

10.1016/j.ensci.2020.100305 ◽

2021 ◽

Vol 22 ◽

pp. 100305

Author(s):

Yuwa Oka ◽

Koji Tsuzaki ◽

Mayu Kamei ◽

Akihiro Kikuya ◽

Toshiaki Hamano

Keyword(s):

Brain Mri ◽

Air Embolism ◽

Mri Findings ◽

Cerebral Air Embolism ◽

Abnormal Brain

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MRI of the Entire Spinal Cord—Worth the While or Waste of Time? A Retrospective Study of 74 Patients with Multiple Sclerosis

Diagnostics ◽

10.3390/diagnostics11081424 ◽

2021 ◽

Vol 11 (8) ◽

pp. 1424

Author(s):

Esben Nyborg Poulsen ◽

Anna Olsson ◽

Stefan Gustavsen ◽

Annika Reynberg Langkilde ◽

Annette Bang Oturai ◽

...

Keyword(s):

Multiple Sclerosis ◽

Spinal Cord ◽

Cervical Spinal Cord ◽

Brain Mri ◽

Anatomical Location ◽

Spinal Cord Lesions ◽

Chi Square ◽

Exact Test ◽

Mcdonald Criteria ◽

Chi Square Test

Spinal cord lesions are included in the diagnosis of multiple sclerosis (MS), yet spinal cord MRI is not mandatory for diagnosis according to the latest revisions of the McDonald Criteria. We investigated the distribution of spinal cord lesions in MS patients and examined how it influences the fulfillment of the 2017 McDonald Criteria. Seventy-four patients with relapsing-remitting MS were examined with brain and entire spinal cord MRI. Sixty-five patients received contrast. The number and anatomical location of MS lesions were assessed along with the Expanded Disability Status Scale (EDSS). A Chi-square test, Fischer’s exact test, and one-sided McNemar’s test were used to test distributions. MS lesions were distributed throughout the spinal cord. Diagnosis of dissemination in space (DIS) was increased from 58/74 (78.4%) to 67/74 (90.5%) when adding cervical spinal cord MRI to brain MRI alone (p = 0.004). Diagnosis of dissemination in time (DIT) was not significantly increased when adding entire spinal cord MRI to brain MRI alone (p = 0.04). There was no association between the number of spinal cord lesions and the EDSS score (p = 0.71). MS lesions are present throughout the spinal cord, and spinal cord MRI may play an important role in the diagnosis and follow-up of MS patients.

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