Acute to Subacute Spinal Cord Infarction Mimicking Acute Multiple Sclerosis: Usefulness of Diffusion-Weighted MRI for Diagnosis

2022 ◽  
Vol 18 ◽  
Author(s):  
Kyoung Yeon Lee ◽  
Eun Kyung Khil ◽  
Sang Won Jo ◽  
Min Uk Jang ◽  
Jung-Ah Choi ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Spinal Cord ◽  
Brain Infarction ◽  
Brain Magnetic Resonance Imaging ◽  
Visual Field Defects ◽  
Unknown Etiology ◽  
Spinal Cord Infarction ◽  
Mri Findings ◽  
Subacute Phase ◽  
Diffusion Weighted

Background: Spinal cord infarction (SCI) is difficult to diagnose because of its rarity, unknown etiology, and unestablished diagnostic criteria. Additionally, the timeline of SCI has not been studied in detail, as few studies using diffusion-weighted image (DWI) sequences of the spine of a small target population have been previously conducted. Case Study: A 56-year-old male with underlying arrhythmia suddenly developed visual field defects on the right side, pain in the left upper extremity, and a tingling sensation in the left hand. Brain Magnetic resonance imaging (MRI) revealed acute to subacute stages of multifocal brain infarction. On additional cervical spinal MRI, it showed atypical MRI findings of SCI, considered late acute to early subacute phase, which were similar to those seen in the acute phase of multiple sclerosis (MS). Additional DWI revealed restricted diffusion. From these findings, it could be inferred that the patient’s SCI occurred at the same time as the multifocal brain infarctions caused by atrial fibrillation. Conclusion: A DWI sequence of spine MRI could be helpful in the diagnosis of acute to subacute phase SCI and in differentiating with acute MS.

scholarly journals Clinical Evaluation of Patients with Spinal Cord Infarction in Mashhad, Iran

2010 ◽  
Vol 2010 ◽  
pp. 1-4 ◽  
Author(s):  
Kavian Ghandehari ◽  
Mohammad Reza Gerami Sarabi ◽  
Parham Maarufi
Keyword(s):  
Spinal Cord ◽  
Clinical Evaluation ◽  
Brain Infarction ◽  
Clinical Syndrome ◽  
Spinal Cord Infarction ◽  
Prospective Clinical Study ◽  
Mri Findings ◽  
Disability Score ◽  
Stroke Registry ◽  
Number Of Patients

Background. Spinal Cord Infarction (SCI) is a rare and disabling disease. This hospital-based study was conducted for clinical evaluation of SCI patients in east of Iran.Methods. Consecutive SCI patients admitted in Ghaem hospital,Mashhad during 2006–2010 were enrolled in a prospective clinical study. Diagnosis of SCI was made by neurologists and radiologists. Demographic features, clinical syndrome, and Magnetic Resonance Imaging (MRI) findings were recorded. All of the patients underwent a standard battery of diagnostic investigations. All of the patients suspected to SCI had MRI of spinal cord at the symptomatic level of cord with a 0.5 Tesla generation, Philips NT Intra, Netherland equipment. An equal number of patients with Brain Infarction (BI) were randomly selected from our stroke registry data bank. Etiology and degree of disability were compared between these groups of patients.Results. Fourteen SCI patients (9 females, 5 males) with mean age38.8±SD: 19.9 years were evaluated. Miscellaneous causes consisted 50% of etiologies in patients with SCI. Uncertain etiology, atherosclerosis, and cardioembolisms consisted 35.7%, 7.1%, and 7.1% of SCI causes, respectively. Distribution of etiologies was significantly different between SCI and BI patients,X2=12.94,df=3,P=.003. Difference in mean disability score at acute phase of stroke was not significant between two studied groups,z=1.54,P=.057. Difference in mean changes of disability score at 90 days postevent was significant in two groups of patients,z=2.65,P=.019.Conclusion. SCI is a rare disease with poor recovery. Distribution of etiologies of SCI patients is quite different than of BI patients.

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.

VZV SPINAL CORD INFARCTION IDENTIFIED BY DIFFUSION-WEIGHTED MRI (DWI)

Neurology ◽  
2007 ◽  
Vol 69 (4) ◽  
pp. 398-400 ◽  
Author(s):  
H. T. Orme ◽  
A. G. Smith ◽  
M. A. Nagel ◽  
R. J. Bert ◽  
T. S. Mickelson ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Infarction ◽  
Diffusion Weighted Mri ◽  
Diffusion Weighted

Breakthrough Disease While on Multiple Sclerosis Immunomodulatory Therapy

2021 ◽  
pp. 55-56
Author(s):  
Jonathan L. Carter
Keyword(s):  
Magnetic Resonance Imaging ◽  
Multiple Sclerosis ◽  
Spinal Cord ◽  
White Matter ◽  
Magnetic Resonance ◽  
Disease Activity ◽  
Brain Magnetic Resonance Imaging ◽  
White Matter Lesions ◽  
Dimethyl Fumarate ◽  
Resonance Imaging

A 36-year-old woman with a history of relapsing-remitting multiple sclerosis was evaluated for new multiple sclerosis symptoms accompanied by new, enhancing, white matter lesions on brain magnetic resonance imaging. Her multiple sclerosis presented with L’hermitte sign when she was 24 years old. She had onset of bilateral lower extremity and left upper extremity tingling at age 26 years. Magnetic resonance imaging and cerebrospinal fluid examination at the time were supportive of the diagnosis of multiple sclerosis, and disease-modifying therapy was recommended by her neurologist. She initiated therapy with dimethyl fumarate at age 30 years after several further relapses. Surveillance magnetic resonance imaging showed new gadolinium-enhancing lesions on brain magnetic resonance imaging on each of 3 consecutive yearly scans. Urine culture and sensitivity tests were performed to rule out occult urinary tract infection; results of this testing were negative. magnetic resonance imaging of the brain concurrently showed new enhancing white matter lesions. The patient was diagnosed with clinical and radiographic breakthrough disease activity while receiving therapy for multiple sclerosis. The patient was treated with 5 days of intravenous methylprednisolone for her relapse. After discussion with the patient, it was decided to transition therapy from dimethyl fumarate to ocrelizumab infusions for her breakthrough disease activity. This decision was further supported by the patient’s concerns that she might be entering an early progressive phase of the disease. In patients with spinal-predominant multiple sclerosis, or with symptoms potentially indicating new spinal cord involvement, it may be necessary to include spinal cord imaging to assess for new disease activity.

scholarly journals Multiple sclerosis: environmental risk factors

1998 ◽  
Vol XXX (1-2) ◽  
pp. 40-42
Author(s):  
Enrico Granieri ◽  
Ilaria Casetta
Keyword(s):  
Risk Factors ◽  
Multiple Sclerosis ◽  
Spinal Cord ◽  
Environmental Factors ◽  
Environmental Risk ◽  
Biological Significance ◽  
Unknown Etiology ◽  
Brain And Spinal Cord ◽  
The Brain

Multiple sclerosis is a disease of unknown etiology characterized by inflammory demyelination of the brain and spinal cord. Epidemiological investigations play important role in study of multiple sclerosis. Geographical distribution of the disease has been described in terms of prevalence and incidence. The possible role of environmental factors as a cause of multiple sclerosis had been hypothesized with observation of unequal geographic distribution of the disease. More interesting, in terms of their biological significance, are attempts to identify associations between multiple sclerosis and situations or events wich could cause blood-brain barrier damages, such as trauma or toxic exposures.

Biplanar MRI for the assessment of the spinal cord in multiple sclerosis

2012 ◽  
Vol 18 (11) ◽  
pp. 1560-1569 ◽  
Author(s):  
Katrin Weier ◽  
Jilla Mazraeh ◽  
Yvonne Naegelin ◽  
Alain Thoeni ◽  
Jochen G Hirsch ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Spinal Cord ◽  
Parallel Imaging ◽  
Proton Density ◽  
Imaging Data ◽  
Lesion Count ◽  
Focal Lesions ◽  
Mri Findings ◽  
Reporting Scheme ◽  
Functional Scores

Objective: To investigate the entire spinal cord (SC) of multiple sclerosis (MS) patients with biplanar MRI and to relate these MRI findings to clinical functional scores. Methods: Two hundred and two patients (140 women, 62 men 24–74 years, Expanded Disability Status Scale (EDSS) scores 0–7.5) were investigated clinically and with biplanar MRI. Sagittal and axial proton density weighted (PDw) and T2 weighted (T2w) images of the whole SC were obtained employing parallel imaging. Data were analyzed by consensus reading using a standardized reporting scheme. Different combinations of findings were compared to EDSS scores with Spearman’s rank correlation coefficient (ρ). Results: The combined analysis of sagittal and axial planes demonstrated slightly differing results in 97/202 (48%) patients. There were 9% additional lesions identified, leading to a higher lesion count in 28% of these patients, but also rejection of equivocal abnormality leading to a lower lesion count in 11% of patients. Considering both sagittal and axial images, SC abnormalities were found in 167/202 (83%) patients. When compared with EDSS scores, the combination of focal lesions, signs of atrophy and diffuse abnormalities showed a moderate correlation (ρ=0.52), that precludes its use for individual patient assessment. Conclusion: Biplanar MRI facilitates a comprehensive identification, localization, and grading of pathological SC findings in MS patients. This improves the confidence and utility of SC imaging.

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.

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