C onversion to multiple sclerosis after a clinically isolated syndrome of the brainstem: cranial magnetic resonance imaging, cerebrospinal fl uid and neurophysiological findings

2003 ◽  
Vol 9 (1) ◽  
pp. 39-43 ◽  
Author(s):  
J Sastre-Garriga ◽  
M Tintoré ◽  
A Rovira ◽  
E Grivé ◽  
I Pericot ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Multiple Sclerosis ◽  
Magnetic Resonance ◽  
Clinically Isolated Syndrome ◽  
Oligoclonal Bands ◽  
Resonance Imaging ◽  
Predictive Values ◽  
Magnetic Resonance Imaging Mri ◽  
Sensitivity Specificity

B ackground and aim: C onversion to multiple sclerosis (MS) after optic neuritis and myelitis has been thoroughly studied; however, limited data are available regarding conversion to MS after a clinically isolated syndrome of the brainstem (CISB). The aim of this study was to investigate conversion to MS in patients with C ISB. Methods: Fifty-one patients with C ISB were prospectively studied. C ranial magnetic resonance imaging (MRI), determination of oligoclonal bands (OBs) in the cerebrospinal fluid (C SF) and evoked potentials (EPs) were performed. Based on conversion to MS at follow-up, the sensitivity, specificity, accuracy and positive and negative predictive values of these tests were calculated. Results: C linically definite MS developed in 18 (35%) patients after a mean follow-up of 37 months. Paty’s MRI criteria showed a sensitivity of 89%, a specificity of 52% and an accuracy of 65%; Fazekas’ criteria showed a sensitivity of 89%, a specificity of 48% and an accuracy of 63%; Barkhof’s criteria showed a sensitivity of 78%, a specificity of 61% and an accuracy of 67%. The presence of O Bs in the C SF showed a sensitivity of 100%, a specificity of 42% and an accuracy of 63%. No differences for neurophysiological parameters were found between patients who did and those who did not convert to MS. C onclusion: Fulfilling Paty’s, Fazekas’ or Barkhof’s MRI criteria and the presence of O Bs in the C SF are associated with a higher risk of conversion to MS in patients with C ISB. Determinatio n of O Bs in the C SF has the greatest sensitivity of all tests. Barkhof’s MRI criteria have greater specificity (although less than previously published for mixed cohorts of clinically isolated syndromes) in predicting conversion to MS for C ISB than either Paty’s or Fazekas’ criteria.

Evaluation of 2016 MAGNIMS MRI criteria for dissemination in space in patients with a clinically isolated syndrome

2017 ◽  
Vol 24 (6) ◽  
pp. 758-766 ◽  
Author(s):  
Jae-Won Hyun ◽  
So-Young Huh ◽  
Woojun Kim ◽  
Min Su Park ◽  
Suk-Won Ahn ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Multiple Sclerosis ◽  
Magnetic Resonance ◽  
Clinically Isolated Syndrome ◽  
Clinical Event ◽  
Resonance Imaging ◽  
Predictive Values ◽  
Mcdonald Criteria ◽  
Sensitivity Specificity

Objectives: We compared validity of 2010 McDonald and newly proposed 2016 Magnetic Resonance Imaging in Multiple Sclerosis (MAGNIMS) criteria for dissemination in space (DIS) in predicting the conversion to clinically definite multiple sclerosis (CDMS) in patients with clinically isolated syndrome (CIS). Methods: Between 2006 and 2016, we enrolled 170 patients who had a first clinical event suggestive of multiple sclerosis (MS) from seven referral hospitals in Korea. Patients were classified into two groups based on the main outcome at the last follow-up: CDMS converters, who experienced a second attack, and non-converters. Results: Of 170 patients with mean follow-up duration of 54 months, 51% converted to CDMS. The sensitivity, specificity, accuracy, and positive and negative predictive values of 2010 McDonald criteria were 70.9%, 63.1%, 67.1%, 66.3%, and 67.9%, and those for 2016 MAGNIMS criteria were 88.4%, 46.4%, 67.7%, 62.8%, and 79.6%, respectively. When we excluded 80 patients who underwent disease-modifying therapy before the second clinical event, the specificity increased to 92.3% and 84.6%, but the sensitivity decreased to 58.8% and 82.4% for 2010 McDonald and 2016 MAGNIMS criteria, respectively. Conclusion: 2016 MAGNIMS magnetic resonance imaging (MRI) criteria for DIS showed higher sensitivity but lower specificity than 2010 McDonald criteria in predicting conversion to CDMS in CIS patients.

Tear analysis in clinically isolated syndrome as new multiple sclerosis criterion

2009 ◽  
Vol 16 (1) ◽  
pp. 87-92 ◽  
Author(s):  
Gauthier Calais ◽  
Gerard Forzy ◽  
Charlotte Crinquette ◽  
Alexandre Mackowiak ◽  
Jerome de Seze ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Multiple Sclerosis ◽  
Cerebrospinal Fluid ◽  
Magnetic Resonance ◽  
Isoelectric Focusing ◽  
Clinically Isolated Syndrome ◽  
Oligoclonal Bands ◽  
Resonance Imaging ◽  
Magnetic Resonance Imaging Mri ◽  
Tear Analysis

In clinically isolated syndrome (CIS), the detection of oligoclonal bands (OCBs) in cerebrospinal fluid (CSF) is critical for space dissemination validation when magnetic resonance imaging (MRI) diagnostic criteria are not fulfilled. However, lumbar puncture for CSF collection is considered relatively invasive. Previous studies have demonstrated applicability of OCB detection in tears to the diagnosis of multiple sclerosis (MS). The objective of the present study was to assess concordance between OCB detection in tears and in CSF. We have prospectively included patients with CIS and compared results of CSF and tear OCB detection by isoelectric focusing (IEF). Tears were collected using a Schirmer strip. We included 82 patients. For 69 of them, samples were analysable. OCBs were detected in CSF for 63.8% and in tears for 42% of patients. All patients with tear OCBs had CSF OCBs. We suggest that tear OCB detection may replace CSF OCB detection as a diagnostic tool in patients with CIS. This would circumvent the practice of invasive lumbar punctures currently used in MS diagnosis.

scholarly journals Periventricular lesions and MS diagnostic criteria in young adults with typical clinically isolated syndromes

2016 ◽  
Vol 23 (7) ◽  
pp. 1031-1034 ◽  
Author(s):  
Wallace J Brownlee ◽  
Katherine A Miszkiel ◽  
Daniel R Altmann ◽  
Olga Ciccarelli ◽  
David H Miller
Keyword(s):  
Magnetic Resonance Imaging ◽  
Multiple Sclerosis ◽  
Magnetic Resonance ◽  
Clinically Isolated Syndrome ◽  
Resonance Imaging ◽  
Mcdonald Criteria ◽  
Specificity And Sensitivity ◽  
Magnetic Resonance Imaging Mri ◽  
Periventricular Lesions ◽  
Periventricular Lesion

In patients who present with a clinically isolated syndrome (CIS), whose features are suggestive of multiple sclerosis (MS), fulfilling McDonald 2010 magnetic resonance imaging (MRI) criteria for dissemination in space (DIS) and dissemination in time (DIT) enables a diagnosis of MS. While ⩾1 periventricular lesion is included in the 2010 DIS criteria, earlier McDonald criteria required ⩾3 periventricular lesions to confirm DIS and recent Magnetic Resonance Imaging in Multiple Sclerosis (MAGNIMS)-recommended DIS criteria also require ⩾3 lesions. We investigated the effect of varying the required number of periventricular lesions and found that the best combination of specificity and sensitivity for clinically definite MS was seen for ⩾1 periventricular lesion using both the McDonald 2010 and MAGNIMS 2016 criteria.

Diffusion-Weighted Magnetic Resonance Imaging of Cholesteatoma Using PROPELLER at 1.5T: A Single-Centre Retrospective Study

2017 ◽  
Vol 68 (2) ◽  
pp. 116-121 ◽  
Author(s):  
Sharon E. Clarke ◽  
Dipan Mistry ◽  
Talal AlThubaiti ◽  
M. Naeem Khan ◽  
David Morris ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Retrospective Study ◽  
Magnetic Resonance ◽  
Predictive Value ◽  
Resonance Imaging ◽  
Predictive Values ◽  
Second Look ◽  
Diffusion Weighted ◽  
Magnetic Resonance Imaging Mri ◽  
Sensitivity Specificity

Purpose The purpose of this study was to evaluate the sensitivity, specificity, and positive and negative predictive values of the diffusion-weighted periodically rotated overlapping parallel lines with enhanced reconstruction (PROPELLER) technique in the detection of cholesteatoma at our institution with surgical confirmation in all cases. Methods A retrospective review of 21 consecutive patients who underwent diffusion-weighted PROPELLER magnetic resonance imaging (MRI) on a 1.5T MRI scanner prior to primary or revision/second-look surgery for suspected cholesteatoma from 2009-2012 was performed. Results Diffusion-weighted PROPELLER had a sensitivity of 75%, specificity of 60%, positive predictive value of 86%, and negative predictive value of 43%. In the 15 patients for whom the presence or absence of cholesteatoma was correctly predicted, there were 2 cases where the reported locations of diffusion restriction did not correspond to the location of the cholesteatoma observed at surgery. Conclusion On the basis of our retrospective study, we conclude that diffusion-weighted PROPELLER MRI is not sufficiently accurate to replace second look surgery at our institution.

Secondary paroxysmal dyskinesia in multiple sclerosis: Clinical–radiological features and treatment. Case report of seven patients

2017 ◽  
Vol 23 (13) ◽  
pp. 1791-1795 ◽  
Author(s):  
Ethel Ciampi ◽  
Reinaldo Uribe-San-Martín ◽  
Jaime Godoy-Santín ◽  
Juan Pablo Cruz ◽  
Claudia Cárcamo-Rodríguez ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Multiple Sclerosis ◽  
Case Report ◽  
Magnetic Resonance ◽  
Adverse Reactions ◽  
Resonance Imaging ◽  
Radiological Features ◽  
Cerebellar Peduncles ◽  
Magnetic Resonance Imaging Mri

Secondary paroxysmal dyskinesias (SPDs) are short, episodic, and recurrent movement disorders, classically related to multiple sclerosis (MS). Carbamazepine is effective, but with risk of adverse reactions. We identified 7 patients with SPD among 457 MS patients (1.53%). SPD occurred in face ( n = 1), leg ( n = 2), or arm +leg ( n = 4) several times during the day. Magnetic resonance imaging (MRI) showed new or enhancing lesions in thalamus ( n = 1), mesencephalic tegmentum ( n = 1), and cerebellar peduncles ( n = 5). Patients were treated with clonazepam and then acetazolamide ( n = 1), acetazolamide ( n = 5), or levetiracetam ( n = 1) with response within hours (acetazolamide) to days (levetiracetam). No recurrences or adverse events were reported after a median follow-up of 33 months.

New-Onset Right-Sided Numbness and Double Vision

2021 ◽  
pp. 14-16
Author(s):  
W. Oliver Tobin
Keyword(s):  
Magnetic Resonance Imaging ◽  
Multiple Sclerosis ◽  
Magnetic Resonance ◽  
Immunoglobulin G ◽  
Clinically Isolated Syndrome ◽  
Resonance Imaging ◽  
Deep White Matter ◽  
The Right ◽  
The Brain

A 40-year-old right-handed man sought care for right hand numbness, right-sided facial numbness, and diplopia progressing to maximal severity over 10 days. At his worst he was unable to write. His symptoms remained maximal for 4 weeks. He was hospitalized and treated with 5 days of intravenous methylprednisolone. He improved to approximately 95% of normal over 4 weeks. He had residual mild right-sided facial and right leg numbness. Antibodies to JC polyoma virus and varicella-zoster virus were positive, which indicated prior exposure to these viruses. Total 25-hydroxyvitamin D level was low at 8.2 ng/mL. Optical coherence tomography findings were normal. Magnetic resonance imaging of the brain performed 3 months after the onset of symptoms demonstrated a T2-hyperintense lesion in the left midbrain peduncle extending into the upper pons, without gadolinium enhancement. A small area of T2 hyperintensity was seen in the right frontal deep white matter. Follow-up brain magnetic resonance imaging showed almost complete resolution of the left midbrain peduncle lesion with persistence of the right frontal deep white matter lesion. Spinal fluid analysis showed 1 white blood cell/µL with 95% lymphocytes, protein 35 mg/dL, 0 unique oligoclonal bands, and normal immunoglobulin G index (0.54). A diagnosis of clinically isolated syndrome-first episode of multiple sclerosis was made. After detailed discussion with the patient, he elected to commence disease-modifying therapy with fingolimod. He underwent routine monitoring with magnetic resonance imaging of the brain and cervical and thoracic spine on an annual basis, without any further relapses at 5-year follow-up. Patients with typical demyelinating syndromes may not always fulfill the diagnostic criteria for multiple sclerosis. After careful exclusion of other mimicking conditions, most notably aquaporin-4-immunoglobulin G– and myelin oligodendrocyte glycoprotein-immunoglobulin G–associated disease, a diagnosis of clinically isolated syndrome may be made.

Multiple sclerosis-associated retrovirus and optic neuritis

2006 ◽  
Vol 12 (3) ◽  
pp. 357-359 ◽  
Author(s):  
S Sotgiu ◽  
G Arru ◽  
M Söderström ◽  
G Mameli ◽  
C Serra ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Multiple Sclerosis ◽  
Cerebrospinal Fluid ◽  
Magnetic Resonance ◽  
Prognostic Factor ◽  
Optic Neuritis ◽  
Resonance Imaging ◽  
Specific Study ◽  
Magnetic Resonance Imaging Mri

One prognostic factor for early multiple sclerosis (MS) patients to develop a definite MS may be the presence of the MS-associated retrovirus (MSRV) in the cerebrospinal fluid (CSF). We designed a specific study on a cohort of optic neuritis (ON) patients to evaluate the MSRV-dependent conversion to MS relative to the prediction conferred by magnetic resonance imaging (MRI) and CSF abnormalities. At follow-up, 33.3% MSRV+ and 0% MSRV− ON patients developed MS ( P=0.03). The prediction value is lower than that given by CSF and MRI abnormalities (42.3%). This intriguing finding is discussed in the light of the abundant discrepancies observed in the MSRV literature.

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