Tumefactive: A Rare First presentation of Multiple Sclerosis

2018 ◽  
Vol 7 ◽  
Author(s):  
Athena Sharifi Razavi
Keyword(s):  
Multiple Sclerosis ◽  
Magnetic Resonance ◽  
Temporal Lobe ◽  
Magnetic Resonance Image ◽  
Cerebral Abscess ◽  
Rare Presentation ◽  
Open Ring ◽  
Demyelinating Lesions ◽  
Mri Characteristics

Abstract Tumefactive demyelinating lesions are a rare presentation of multiple sclerosis (MS). Diagnosis of tumefactive is commonly carried out using magnetic resonance image (MRI). Tumefactive diagnosis is difficult because of may similar to the clinical and MRI characteristics of glioma or a cerebral abscess. We presented a 35-years-old female with one episode of secondary generalized seizure after delivery. In MRI with contrast, two gadolinium-enhanced lesions were observed in right temporal lobe with open-ring appearance.

Grey matter abnormalities in multiple sclerosis: proton magnetic resonance spectroscopic imaging

2001 ◽  
Vol 7 (4) ◽  
pp. 221-226 ◽  
Author(s):  
Rakesh Sharma ◽  
Ponnada A Narayana ◽  
Jerry S Wolinsky
Keyword(s):  
Multiple Sclerosis ◽  
Magnetic Resonance ◽  
Proton Magnetic Resonance ◽  
Magnetization Transfer ◽  
Spectroscopic Imaging ◽  
Magnetic Resonance Spectroscopic Imaging ◽  
Relapsing Remitting ◽  
Cortical Gray Matter ◽  
Magnetic Resonance Imaging Mri ◽  
Mri Characteristics

Pathologically defined abnormalities in the cortical gray matter (GM) are well described in multiple sclerosis (MS) but are infrequently seen by conventional magnetic resonance imaging (MRI). We systematically evaluated 52 relapsing - remitting MS patients and 20 normal volunteers with high resolution MRI and short echo proton magnetic resonance spectroscopic imaging (MRSI). Individual tissue contributions to the spectroscopic voxels were estimated based on MRI that incorporated both CSF suppression and magnetization transfer, or double inversion images in which both CSF and GM were suppressed. Strong resonances in the 0.8 to 1.5 p.p.m. spectral region were observed in 13 MS patients. Image segmentation based on the MRI characteristics of tissues contributing to the spectroscopic voxels showed that these additional peaks originated mainly from GM. The presence of these additional peaks suggests that the normal appearance GM on MRI, is biochemically abnormal in a substantial proportion of relapsing-remitting MS patients.

Multiple Sclerosis and Cognitive Impairment

2021 ◽  
pp. 39-41
Author(s):  
Cristina Valencia-Sanchez ◽  
Jonathan L. Carter
Keyword(s):  
Magnetic Resonance Imaging ◽  
Multiple Sclerosis ◽  
Cognitive Impairment ◽  
Information Processing ◽  
Magnetic Resonance ◽  
Processing Speed ◽  
Rehabilitation Program ◽  
Resonance Imaging ◽  
The Past ◽  
Demyelinating Lesions

A 60-year-old woman with a history of multiple sclerosis was evaluated for cognitive concerns. At age 30 years she had an episode of optic neuritis, followed by an episode of bilateral lower extremity numbness at age 35 years. In the following years, she had at least 6 further multiple sclerosis relapses, the last one approximately 3 years before the current presentation. She was initially treated with interferon, but she did not tolerate it. She had been taking glatiramer acetate for the past 3 years. She had noticed progressive deterioration of her gait for the past 3 years, having to use a cane on occasions. Magnetic resonance imaging of the brain showed multiple demyelinating lesions), and magnetic resonance imaging of the cervical spine showed 1 small demyelinating lesion at C6. Vitamin B12 level and thyroid function were normal. Comprehensive neuropsychological testing showed multidomain cognitive impairment, mainly impairment of speed of information processing, spatial discrimination skills, and attention/concentration. The patient’s multiple sclerosis phenotype was consistent with secondary progressive multiple sclerosis. Her cognitive impairment profile, mainly affecting information processing speed and disinhibition suggestive of frontal dysfunction, was consistent with multiple sclerosis. The patient began a cognitive rehabilitation program, and learning and memory aids were recommended. Lifestyle changes were also recommended, including weight loss and physical exercise. She was given recommendations for sleep hygiene and began taking gabapentin for neuropathic pain and restless legs. Cognitive impairment is common in patients with multiple sclerosis. Slowed cognitive processing speed and episodic memory decline are the most common cognitive deficits in MS, with additional difficulties in executive function, verbal fluency, and visuospatial analysis.

Characterization of tumefactive demyelinating lesions using MR imaging and in-vivo proton MR spectroscopy

2008 ◽  
Vol 15 (2) ◽  
pp. 193-203 ◽  
Author(s):  
HS Malhotra ◽  
KK Jain ◽  
A Agarwal ◽  
MK Singh ◽  
SK Yadav ◽  
...  
Keyword(s):  
Resonance Spectroscopy ◽  
Post Contrast ◽  
Open Ring ◽  
Apparent Diffusion ◽  
Demyelinating Lesions ◽  
Fluid Attenuated Inversion Recovery ◽  
Adc Values ◽  
Mri Characteristics

Background and Objectives Diagnosis of tumefactive demyelinating lesions (TDLs) is challenging to both clinicians and radiologists. Our objective in this study was to analyze and characterize these lesions clinically, biochemically, electrophysiologically, and on imaging. Methods A retrospective analysis with prospective follow-up of 18 cases of TDLs was performed. Imaging included T2-, T1-weighted, fluid-attenuated inversion recovery (FLAIR), post-contrast T1-weighted, diffusion weighted imaging (DWI), and proton magnetic resonance spectroscopy (PMRS). Results All the lesions appeared hyperintense on T2 and FLAIR images. Increased Apparent diffusion coefficient (ADC) (0.93–2.21 × 10−3 mm2/s) in centre of the lesion was seen in 14/18 cases; however, peripheral restriction (ADC values 0.55–0.64 × 10−3 mm2/s) was noted in 11/18 cases. In all, 13/18 cases showed contrast enhancement with open ring ( n = 5), complete ring ( n = 1), minimal ( n = 4), and infiltrative ( n = 3) pattern of enhancement. Nine of these 13 cases also showed venular enhancement. On PMRS, nine showed glutamate/glutamine (Glx) at 2.4 ppm. Conclusion Clinical features along with several MRI characteristics such as open ring enhancement, peripheral restriction on DWI, venular enhancement, and presence of Glx on spectroscopy may be rewarding in differentiating TDLs from neoplastic lesions.

An unusual presentation of multiple sclerosis

1994 ◽  
Vol 24 (2) ◽  
pp. 525-529 ◽  
Author(s):  
M. H. Hotopf ◽  
S. Pollock ◽  
W. A. Lishman
Keyword(s):  
Magnetic Resonance Imaging ◽  
Multiple Sclerosis ◽  
Cerebrospinal Fluid ◽  
Magnetic Resonance ◽  
Resonance Imaging ◽  
Cerebrospinal Fluid Analysis ◽  
Rare Presentation ◽  
Fluid Analysis ◽  
Electrophysiological Tests ◽  
Male Patients

SynopsisTwo male patients who presented with unusual pictures of dementia in the absence of other obvious symptoms or signs are reported. Investigations demonstrated changes highly suggestive of multiple sclerosis (MS) on magnetic resonance imaging, cerebrospinal fluid analysis and electrophysiological tests. We suggest this represents a rare presentation of multiple sclerosis.

scholarly journals Alterações na Ressonância Magnética Preditoras da Conversão da Síndrome Clinicamente Isolada em Esclerose Múltipla

2016 ◽  
Vol 29 (11) ◽  
pp. 742 ◽  
Author(s):  
Sara Peixoto ◽  
Pedro Abreu
Keyword(s):  
Magnetic Resonance Imaging ◽  
Multiple Sclerosis ◽  
Magnetic Resonance ◽  
Diagnostic Criteria ◽  
Clinically Isolated Syndrome ◽  
Conventional Magnetic Resonance Imaging ◽  
Resonance Imaging ◽  
Conventional Magnetic Resonance ◽  
Pubmed Database ◽  
Demyelinating Lesions

Introduction: Clinically isolated syndrome may be the first manifestation of multiple sclerosis, a chronic demyelinating disease of the central nervous system, and it is defined by a single clinical episode suggestive of demyelination. However, patients with this syndrome, even with long term follow up, may not develop new symptoms or demyelinating lesions that fulfils multiple sclerosis diagnostic criteria. We reviewed, in clinically isolated syndrome, what are the best magnetic resonance imaging findings that may predict its conversion to multiple sclerosis.Material and Methods: A search was made in the PubMed database for papers published between January 2010 and June 2015 using the following terms: ‘clinically isolated syndrome’, ‘cis’, ‘multiple sclerosis’, ‘magnetic resonance imaging’, ‘magnetic resonance’ and ‘mri’.Results: In this review, the following conventional magnetic resonance imaging abnormalities found in literature were included: lesion load, lesion location, Barkhof’s criteria and brain atrophy related features. The non conventional magnetic resonance imaging techniques studied were double inversion recovery, magnetization transfer imaging, spectroscopy and diffusion tensor imaging.Discussion: The number and location of demyelinating lesions have a clear role in predicting clinically isolated syndrome conversion to multiple sclerosis. On the other hand, more data are needed to confirm the ability to predict this disease development of non conventional techniques and remaining neuroimaging abnormalities.Conclusion: In forthcoming years, in addition to the established predictive value of the above mentioned neuroimaging abnormalities,different clinically isolated syndrome neuroradiological findings may be considered in multiple sclerosis diagnostic criteria and/or change its treatment recommendations.

Progressive Left Lower Extremity Weakness and Thoracic Spinal Cord Lesion

2021 ◽  
pp. 17-19
Author(s):  
B. Mark Keegan
Keyword(s):  
Magnetic Resonance Imaging ◽  
Multiple Sclerosis ◽  
Magnetic Resonance ◽  
Lower Extremity ◽  
Motor Vehicle ◽  
Resonance Imaging ◽  
Lower Extremity Weakness ◽  
Left Lower Extremity ◽  
Demyelinating Lesions ◽  
T2 Hyperintensity

A 76-year-old man was seen for a neurologic evaluation with concerns of progressive left lower extremity weakness. He had 2 lumbar spinal operations, the most recent being at age 68 years, and had a major motor vehicle accident with a pelvic fracture at age 67 years. He was documented to have new impairment in right ankle and distal lower extremity power after the operations and trauma. He began using a left-sided ankle-foot orthosis but used no other gait aid. Brain magnetic resonance imaging revealed 2 prominent and stable T2-signal hyperintensities in the frontal cerebral white matter, with some periventricular T2 hyperintensity with associated T1 hypointensity, and no gadolinium-enhancing lesions or posterior fossa lesions. Sagittal and axial magnetic resonance imaging of the thoracic spine showed an area of T2-signal abnormality without enhancement in the left hemicord at the T3 to T4 level. Nerve conduction studies and electromyography revealed a chronic right L5 radiculopathy without evidence of active denervation as the cause of the right lower motor neuron lower extremity weakness. He was diagnosed with progressive paucisclerotic multiple sclerosis with a primary progressive disease course. The use of ocrelizumab (anti-CD20) was considered initially. However, the exceedingly slow disease progression over many decades and the lack of new magnetic resonance imaging lesions or gadolinium-enhancing lesions, as well as his age, were taken into consideration, and conservative rehabilitation management was recommended instead. It is being increasingly recognized that the location of demyelinating disease lesions may be of crucial importance in the development of motor progression in multiple sclerosis. These critical demyelinating lesions are observed in patients with progressive unilateral hemiparetic impairment due to multiple sclerosis, in which unlimited lesion burden is allowable.

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