Multiple sclerosis and serial computerized tomography. Delayed contrast enhancement of acute and early lesions

Multiple sclerosis: relations between MRI and CT findings, cerebrospinal fluid parameters and clinical features

Cerebral MRI and CT findings were compared with various cerebrospinal fluid (CSF) parameters and clinical features in 75 patients with multiple sclerosis (MS). There were positive correlations between CSF albumin as a parameter of blood-brain barrier function and morphological parameters, namely the number of nonperiventricular foci and periventricular involvement demonstrated by MRI and ventricular enlargement as shown by CT. Apart from positive correlations between the number of nonperiventricular foci and CSF levels of IgA and IgG, including the IgG synthetic rate, no other correlations were found between CSF parameters (leucocyte count and immunoglobulin concentrations) and morphological findings. The unremitting-progressive type of MS was distinguished from the relapsing-remitting form by a lower CSF leucocyte count and a higher degree of disability, but there was no difference between the morphological findings in the two forms. Positive correlations were found between degree of disability and both periventricular involvement in the MRI and CT evidence of ventricular enlargement. In terms of correlations with the duration of disease, cerebral MRI proved to be far superior to CSF evaluations.

Relationship of nuclear magnetic resonance examinations to clinical data, cerebrospinal fluid findings and visual evoked potentials in multiple sclerosis

We examined 150 patients with a 0.5 Tesla MR system. Fourteen patients were excluded from the study, because, in addition to the clinical signs of multiple sclerosis, they showed other abnormalities (spinal canal narrowing, embolic disease, Vitamin B12 deficiency, etc.). The results of the 136 examinations were related to the duration of disease, index of impairment on Kurtkze's disability scale, the clinical course, and the CSF and VEP results. The MR studies were evaluated in a semiquantitative manner. Patients with a long duration of disease demonstrated more changes than did cases with a short course. We found more periventricular confluences and more white matter plaques in the centrum semiovale. In addition, more lesions were seen in patients with a severe course of disease. All patients with negative CSF results (n = 13) showed positive MR examinations, and vice versa, patients with positive CSF findings showed negative MR results (n = 5). First results of a follow-up study demonstrate that most abnormalities in MR are not related to the clinical course or therapeutical procedure.

Multiple sclerosis disease activity correlates with gadolinium-enhanced magnetic resonance imaging

Magnetic resonance imaging provides a method of visualizing multiple sclerosis plaques, but the age and activity of these plaques cannot be determined with routine magnetic resonance images. Gadolinium DTPA is a paramagnetic contrast agent that does not cross an intact blood-brain barrier. We studied 16 patients with multiple sclerosis, using magnetic resonance imaging, gadolinium-enhanced magnetic resonance imaging, and computed tomographic scans. Gadolinium enhancement of multiple sclerosis plaques correlated with the clinical activity of the disease and corresponded anatomically with the symptoms and signs. We conclude that gadolinium enhancement of magnetic resonance images is a promising tool in the investigation of multiple sclerosis lesions and that it may provide a method for objective follow-up in clinical trails.

Breakdown of the blood-retinal barrier in multiple sclerosis measured by vitreous fluorophotometry

Periphlebitis retinae in multiple sclerosis appears as transitory cellular infiltrations around veins in an otherwise normal retina. Similar cellular infiltrations have been found around veins in the central nervous system. In the present study the blood-retinal barrier has been investigated by vitreous fluorophotometry. Eight multiple sclerosis patients with actual periphlebitis retinae and 9 patients with previous but not active periphlebitis retinae were included in this study. Abnormal leakage of fluorescein was manifest in the group of multiple sclerosis patients with periphlebitis retinae. Permeability (1.8 +/- 0.2 X 10(-7) cm/sec; mean +/- SEM) but not in the control group as a whole permeability (1.3 +/- 0.1 X 10(-7) cm/sec; mean +/- SEM) compared to 17 normals (permeability 1.1 +/- 0.005). It is thus concluded that breakdown of the blood-retinal barrier may be transitory when connected with periphlebitis retinae in multiple sclerosis.

SSEP chronotopography in patients with multiple sclerosis

In 10 patients with definite MS, an SSEP chronotopogram was constructed of 7 different, well-defined components: N20, P25, P45, P100, N140, P200 and P300. Chronotopographical maps were constructed on the basis of the localization of maximal amplitudes of the different components and their dipolar counterparts (when present). Most patients showed a delay of different specific as well as aspecific components. The chronotopogram was not much different from normal except for P45. Most generators therefore seem to stay stable. One of the P45 dipole generators vanished, probably due to a slight change in its direction, or more probably as a consequence of loss of association fibres in the cortical white matter. Spatio-temporal mapping provides new, clinically relevant information. The development of automatic methods for this mapping is justified for routine clinical use in neurology.

Effect of high-dose intravenous steroid administration on contrast-enhancing computed tomographic scan lesions in multiple sclerosis

Six consecutive patients with multiple sclerosis and lesions contrast enhancing on computed tomographic scan were treated with high-dose intravenous infusions of methylprednisolone. Double-dose delayed computed tomographic scans were repeated at varying intervals during corticosteroid treatment. Contrast enhancement of sclerotic plaques was reduced or eliminated within as little as 8 hours after the first infusion. Rapid associated partial clinical improvement was noted in four patients with recent exacerbations of disease activity. Similar attenuation of contrast-enhancing plaques and clinical improvement were less predictable following oral corticosteroid therapy in conventional dosage. These studies suggest that the dose, route of administration, and duration of corticosteroid therapy in multiple sclerosis may partially determine the effect of treatment.

Impairment of blood-cerebrospinal fluid barrier in multiple sclerosis

The blood-CSF barrier (BCB) function in active multiple sclerosis (MS) was studied by means of CSF proteins analysis using disc electrophoresis and immunofixation. Forty-five CSF samples were obtained by repeat lumbar punctures at various intervals, from four autopsy-proven cases and three male and nine female patients with clinically definite MS. When total protein content was increased, the percentages of prealbumin and tau fraction were decreased significantly in association with the presence of haptoglobin (Hp) polymers in nearly all the samples, as a result of increased permeability of the BCB. Even when the total protein content was normal, Hp polymers were detected in 56% of the samples, and the tau fraction tended to be decreased. Monoclonal immunoglobulin and Hp polymers were both recognized in some cases. The results suggested a more frequent occurrence of BCB impairment in MS than had formerly been revealed by CSF albumin analysis, and accorded with the recent reports of contrast-enhancing lesions of MS brain in computerized tomography.

Computerized axial tomography and diagnosis of multiple sclerosis

Computed axial tomography (C.T.) findings are illustrated in 3 patients who presented with C.T. changes suggesting respectively chronic M.S., acute M.S., and an appearance simulating a malignant tumour. Review of the literature shows that the chronic form with cerebral atrophy and low density lesions in the hemispheres is common in patients with a long history and is unlikely to cause diagnostic difficulty. The acute presentation is less common and could be confused with a variety of causes of multiple low density enhancing lesions. The C.T. diagnosis of M.S. is more difficult in rare cases in which plaques cause mass effect and show ring enhancement; all 3 such cases in the literature were subjected to cerebral biopsy.

Cranial computed tomography in the diagnosis of multiple sclerosis

A group of 202 patients with suspected, probable or definite multiple sclerosis was studied, using cranial computed tomography (CT). Atrophy alone, or in combination with white-matter and periventricular lucencies, and areas of contrast enhancement, were the main abnormal findings in 52% of patients. Atrophy was detected in 44% of patients, and its frequency and severity correlated with disease duration up to 10 years, age, and disease category. Atrophic changes in the brainstem and cerebellum could be correlated with clinical data more often than supratentorial atrophy could be correlated with features such as dementia or mood changes. Lucencies in the white matter, thought to represent areas of demyelination, were noted in 21% of patients, and only a proportion of these lesions could be correlated with clinical data, the others being clinically silent. Contrast enhancement was seen in a small proportion of white-matter lesions, and was independent of disease activity and steroid medication. Electrophysiological tests and cerebrospinal fluid analysis showed a higher yield of abnormality than CT scanning in cases with suspected or possible multiple sclerosis, though in such patients CT scanning excluded alternative cerebral atrophy. Modifications of the technique of CT scanning may improve the detection rate of white-matter lesions, thereby enhancing the value of CT as a diagnostic tool in the study of patients with multiple sclerosis.

Multiple sclerosis with clinical and radiological features of cerebral tumour

Three cases of multiple sclerosis, all confirmed pathologically, are described in whom both the unusual clinical features and the CT scan appearances suggested cerebral tumours. The failure of mass effect reliably to differentiate plaques and tumours on a CT scan is stressed and the literature relating to CT scanning in multiple sclerosis is reviewed.

Relation between EEG and disability scores in multiple sclerosis

A disability-scoring and an EEG-spectral analysis was performed in patients suffering from clinically and biochemically (oligoclonal aspect in cerebro-spinal fluid) proven multiple sclerosis at two stages of their illness, that are before and after a short intensive immuno suppressive therapy. In both stages a relationship is found between the degree of disability and the amount of beta activity in the fronto-central area and the amount of the theta activity in the temporal area. Significant improvement in the clinical state of the patient and a marked increase of the mean alpha frequency in the parietooccipital region could be demonstrated after short intensive immunosuppressive therapy.