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Rook J, Llufriu S, de Kok D, Rofes A. Language impairments in people with autoimmune neurological diseases: A scoping review. JOURNAL OF COMMUNICATION DISORDERS 2023; 106:106368. [PMID: 37717472 DOI: 10.1016/j.jcomdis.2023.106368] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 08/02/2023] [Accepted: 08/16/2023] [Indexed: 09/19/2023]
Abstract
INTRODUCTION Autoimmune neurological diseases (ANDs) are a specific type of autoimmune disease that affect cells within the central and peripheral nervous system. ANDs trigger various physical/neuropsychiatric symptoms. However, language impairments in people with ANDs are not well characterized. Here we aimed to determine the kinds of language impairment that most commonly emerge in 10 ANDs, the characteristics of the patients (demographic, neurological damage), and the assessment methods used. METHODS We followed the PRISMA Extension for Scoping Reviews (PRISMA-ScR). PubMed and Google Scholar were searched. We used a list of search terms containing 10 types of ANDs (e.g., multiple sclerosis, acute disseminated encephalomyelitis) in combination with the terms aphasia, dysphasia, fluency, language, listening, morphology, phonology, pragmatics, reading, semantics, speaking, syntax, writing. The reference lists and citations of the relevant papers were also investigated. The type of AND, patient characteristics, neurological damage and examination technique, language tests administered, and main findings were noted for each study meeting the inclusion criteria. RESULTS We found 171 studies meeting our inclusion criteria. These comprised group studies and case studies. Language impairments differed largely among types of ANDs. Neurological findings were mentioned in most of the papers, but specific language tests were rarely used. CONCLUSIONS Language symptoms in people with ANDs are commonly reported. These are often not full descriptions or only focus on specific time points in the course of the disease. Future research needs to assess specific language functions in people with ANDs and relate their language impairments to brain damage at different stages of disease evolution.
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Affiliation(s)
- Janine Rook
- Center for Language and Cognition, University of Groningen, Groningen, The Netherlands; Research School of Behavioural and Cognitive Neurosciences, University of Groningen, Groningen, The Netherlands
| | - Sara Llufriu
- Center of Neuroimmunology, Laboratory of Advanced Imaging in Neuroimmunological Diseases, Hospital Clinic Barcelona, August Pi i Sunyer Biomedical Research Institute (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Dörte de Kok
- Center for Language and Cognition, University of Groningen, Groningen, The Netherlands
| | - Adrià Rofes
- Center for Language and Cognition, University of Groningen, Groningen, The Netherlands.
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Zhang Y, Zhang T, Zhang X, Yan X, Lei J, Liu R, Yang Y, Zhang C, Zhang J, Zhang Y, Yue W. Clinical spectrum and prognosis of pathologically confirmed atypical tumefactive demyelinating lesions. Sci Rep 2023; 13:7773. [PMID: 37179394 PMCID: PMC10183015 DOI: 10.1038/s41598-023-34420-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 04/29/2023] [Indexed: 05/15/2023] Open
Abstract
To describe the clinical spectrum and prognosis of atypical tumefactive demyelinating lesions (TDLs), which were confirmed by pathology. A total of 11 patients were diagnosed with atypical TDLs confirmed by brain biopsy and surgery between January 2006 and December 2017. The clinical spectrum and prognosis in these patients were analyzed. The patients' ages ranged from 29 to 62 years, with a mean age of 48.9 years; 72.7% were males. The Expanded Disability Status Scale (EDSS) of the patients with first onset was 2.36. Most of the patients started with limb numbness and weakness (45.5%) or alalia (27.2%). The mean time from symptom onset to biopsy or surgery was 12.9 days (3-30 days). Most of the patients had solitary lesions (72.7%), supratentorial lesions (90.9%, particularly predominant in the frontal, temporal, and parietal lobes), moderate edema (63.6%), mild mass effect (54.5%), and patchy lesions (54.5%). Among them, three patients were positive for myelin basic protein (MBP) and one patient was positive for myelin oligodendrocyte glycoprotein (MOG). The patients were followed up for an average of 6.9 years (2-14 years), and recurrent TDLs were observed in 2 patients. Except for the 2 patients who relapsed, only 1 of the 9 patients died; the other 8 patients improved or maintained the status quo (the EDSS scores were lower or unchanged). The patients did not have any serious nervous system injury at onset, and the main presentation included extremity weakness, headache or dizziness, and alalia. The most common form was patchy on MRI enhancement. Cerebrospinal fluid and demyelination test can be an indicator of TDLs, and seizures may be a poor prognostic indicator. Most atypical TDLs have monophasic courses and good outcomes. The effect of neurosurgery alone was good in our group, and the effect of surgery on atypical TDLs can be further studied.
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Affiliation(s)
- Yajing Zhang
- Department of Neurology, Tianjin Huanhu Hospital, Jizhao Road 6, Tianjin, 300060, Jinnan, China
| | - Ting Zhang
- Department of Neurology, Tianjin Huanhu Hospital, Jizhao Road 6, Tianjin, 300060, Jinnan, China
| | - Xuebin Zhang
- Department of Pathology, Tianjin Huanhu Hospital, Tianjin, China
| | - Xiaoling Yan
- Department of Pathology, Tianjin Huanhu Hospital, Tianjin, China
| | - Jing Lei
- Imaging Department, Tianjin Huanhu Hospital, Tianjin, China
| | - Ran Liu
- Department of Neurology, Tianjin Huanhu Hospital, Jizhao Road 6, Tianjin, 300060, Jinnan, China
| | - Yun Yang
- Department of Neurology, Tianjin Huanhu Hospital, Jizhao Road 6, Tianjin, 300060, Jinnan, China
| | - Chao Zhang
- Department of Neurology, Tianjin Huanhu Hospital, Jizhao Road 6, Tianjin, 300060, Jinnan, China
| | - Jun Zhang
- Department of Neurology, Tianjin Huanhu Hospital, Jizhao Road 6, Tianjin, 300060, Jinnan, China
| | - Ying Zhang
- Department of Neurology, Tianjin Huanhu Hospital, Jizhao Road 6, Tianjin, 300060, Jinnan, China
| | - Wei Yue
- Department of Neurology, Tianjin Huanhu Hospital, Jizhao Road 6, Tianjin, 300060, Jinnan, China.
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Losavio FA, Mirabella M, Tricoli L, Silvestri G, De Fino C, Lucchini M, Nociti V. A unique case of multiphasic ADEM or what else? Mult Scler Relat Disord 2019; 35:73-75. [PMID: 31351264 DOI: 10.1016/j.msard.2019.07.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Accepted: 07/19/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Acute disseminated encephalomyelitis (ADEM) is a monophasic post-infectious demyelinating disease, clinically defined by the acute onset of polyfocal neurological deficits including encephalopathy. A subset of ADEM patients will subsequently be diagnosed with relapsing disorders, including recurrent DEM (RDEM), multiphasic DEM (MDEM), neuromyelitis optica spectrum disorders (NMOSD) and multiple sclerosis (MS). Here we describe the case of an adult patient, who presented two ADEM-like episodes after a very long (8 years) symptoms-free period. CLINICAL CASE A 48 years old man presented a first case of sub-acute onset of encephalopathy and dysarthria with MRI findings suggestive for ADEM for which he underwent an intravenous and oral steroid treatment followed by a complete clinical remission. After 8 years he presented a new sub-acute onset of encephalopathy and balance disorders with the onset of new lesions at the MRI. The search for oligoclonal band (OCB) showed a single CSF-restricted IgG band. Suspecting a new ADEM episode he was treated with intravenous steroids without benefit and 3 apheresis sessions with clinical improvement followed by an oral steroid treatment. After 2 months he experienced a paroxysmal episode of dysarthria, upper and lower left limbs impairment and urge incontinence with a stable new brain and spinal cord MRI. The search for anti-aquaporin-4 and anti-MOG (cell-based assay) antibodies was repeated twice within a 6 months span and resulted in both cases negative. The patient was treated with Rituximab (1g followed by 1g after 15 days, followed by 1g after 6 months) with stability of the neurological and radiological examinations at the last follow-up. CONCLUSIONS To the best of our knowledge, this is the first case of MDEM in which the two episodes of ADEM occurred 8 years apart. Although this case fulfills the diagnostic criteria for MDEM, the time elapsed between the two episodes is very long. Therefore, we cannot exclude that this disease might be a new nosological entity that could be included in the expanding range of demyelinating diseases.
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Affiliation(s)
- Francesco Antonio Losavio
- Institute of Neurology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, 00168 Rome, Italy
| | - Massimiliano Mirabella
- Institute of Neurology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, 00168 Rome, Italy
| | - Luca Tricoli
- Institute of Neurology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, 00168 Rome, Italy
| | - Gabriella Silvestri
- Institute of Neurology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, 00168 Rome, Italy
| | - Chiara De Fino
- Institute of Neurology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, 00168 Rome, Italy
| | - Matteo Lucchini
- Institute of Neurology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, 00168 Rome, Italy
| | - Viviana Nociti
- Institute of Neurology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, 00168 Rome, Italy.
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Shah S, Shah D, Skeen MB. Recurrent disseminated encephalomyelitis: A case report and literature review. Mult Scler Relat Disord 2018; 26:86-89. [DOI: 10.1016/j.msard.2018.09.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Revised: 08/13/2018] [Accepted: 09/10/2018] [Indexed: 11/17/2022]
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Guison J, Groza M, Stoica O, Blaison G. Un cas d’encéphalomyélite aiguë disséminée post-infectieuse découvert devant une rétention vésicale fébrile. Rev Med Interne 2017; 38:278-281. [DOI: 10.1016/j.revmed.2016.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Revised: 06/07/2016] [Accepted: 06/21/2016] [Indexed: 10/21/2022]
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Wan DL, Ren KW, Zhang LL, Wang B, Zhai ZL, Zhang XY, Yang YC, Zheng SS. Liver Transplant Recipient With Tumefactive Demyelinating Lesions: A Case Report and Literature Review. Transplant Proc 2016; 48:3197-3202. [PMID: 27932180 DOI: 10.1016/j.transproceed.2016.03.034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2016] [Revised: 03/17/2016] [Accepted: 03/30/2016] [Indexed: 10/20/2022]
Abstract
Tumefactive demyelinating lesions (TDLs) that may resemble brain neoplasms or abscesses are uncommon but noteworthy. A solid knowledge of how to distinguish TDLs from malignancy or infection is a key step to avoid unnecessary medical or surgical interventions. Almost all the intracranial demyelination diseases after liver transplantation (LT) refer to central pontine myelinolysis or extrapontine myelinolysis; TDLs after LT have never been reported. In 2005, a 45-year-old Chinese male underwent orthotopic LT due to "acute on chronic liver failure" in our hospital. He took triple anti-rejection drugs including tacrolimus, mycophenolate mofetil, and corticosteroids after LT. In 2010, he was admitted for right limb weakness, and the head magnetic resonance imaging and magnetic resonance spectroscopy revealed the lesions were more likely to be TDLs. His symptoms disappeared after he was administered corticosteroid therapy which proved the diagnosis. Five years later, he was admitted again to hospital with dizziness and double version. The magnetic resonance image and magnetic resonance spectroscopy showed that the new solitary lesion in the cerebellum may in fact be the new TDL. He received corticosteroid therapy and was discharged after symptoms improved. Herein, to our knowledge, we reported the first case of TDL after LT. We reported this case to provide helpful information to clinicians about intracranial demyelination diseases after LT which maybe are not always central pontine myelinolysis or extrapontine myelinolysis.
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Affiliation(s)
- D-L Wan
- Laboratory of Combined Multi-organ Transplantation, Ministry of Public Health, Key Laboratory of Organ Transplantation, Division of Hepatobiliary and Pancreatic Surgery, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, China
| | - K-W Ren
- Laboratory of Combined Multi-organ Transplantation, Ministry of Public Health, Key Laboratory of Organ Transplantation, Division of Hepatobiliary and Pancreatic Surgery, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, China
| | - L-L Zhang
- Laboratory of Combined Multi-organ Transplantation, Ministry of Public Health, Key Laboratory of Organ Transplantation, Division of Hepatobiliary and Pancreatic Surgery, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, China
| | - B Wang
- Laboratory of Combined Multi-organ Transplantation, Ministry of Public Health, Key Laboratory of Organ Transplantation, Division of Hepatobiliary and Pancreatic Surgery, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, China
| | - Z L Zhai
- Laboratory of Combined Multi-organ Transplantation, Ministry of Public Health, Key Laboratory of Organ Transplantation, Division of Hepatobiliary and Pancreatic Surgery, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, China
| | - X-Y Zhang
- Laboratory of Combined Multi-organ Transplantation, Ministry of Public Health, Key Laboratory of Organ Transplantation, Division of Hepatobiliary and Pancreatic Surgery, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, China
| | - Y-C Yang
- Laboratory of Combined Multi-organ Transplantation, Ministry of Public Health, Key Laboratory of Organ Transplantation, Division of Hepatobiliary and Pancreatic Surgery, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, China
| | - S-S Zheng
- Laboratory of Combined Multi-organ Transplantation, Ministry of Public Health, Key Laboratory of Organ Transplantation, Division of Hepatobiliary and Pancreatic Surgery, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, China.
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Idiopathic Transverse Myelitis Mimicking an Intramedullary Spinal Cord Tumor. Case Rep Pathol 2016; 2016:8706062. [PMID: 27672469 PMCID: PMC5031842 DOI: 10.1155/2016/8706062] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Accepted: 08/23/2016] [Indexed: 11/17/2022] Open
Abstract
The differential diagnoses for spinal cord lesions include spinal tumors and inflammatory processes. The distinction between these pathologies can be difficult if solely based on imaging. We report for the first time to our knowledge a case of idiopathic transverse myelitis (ITM) mimicking a discrete cervical spinal lesion in a 66-year-old man who presented with gait instability and neck pain. The patient's symptoms failed to resolve after an initial course of steroid therapy. Surgical biopsy confirmed the diagnosis of ITM. Subsequent treatment with dexamethasone resulted in complete resolution of the symptoms as well as the intramedullary enhancement. ITM is most common in the cervical and thoracic spine, spanning 3-4 spinal segments. It usually occupies more than 50% of the cross-sectional area of the spinal cord and tends to be central, uniform, and symmetric. It exhibits patchy and peripheral contrast enhancement. These criteria are useful guidelines that help distinguish ITM from neoplastic spinal lesions. A decision to perform biopsy must take into consideration the patient's clinical symptoms, the rate of progression of neurological deficits, and the imaging characteristics of the lesion. Surgical biopsy for questionable lesions should be reserved for patients with progressive neurological deficits refractory to empirical medical therapy.
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9
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van Rensburg SJ, van Toorn R, Moremi KE, Peeters AV, Oguniyi A, Kotze MJ. Multiple sclerosis-like diagnosis as a complication of previously treated malaria in an iron and vitamin D deficient Nigerian patient. Metab Brain Dis 2016; 31:197-204. [PMID: 26746433 DOI: 10.1007/s11011-015-9788-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2015] [Accepted: 12/28/2015] [Indexed: 02/06/2023]
Abstract
In contrast to malaria, multiple sclerosis (MS) is infrequently found in Black Africans. We describe a 29 year old Nigerian female who developed an MS-like condition with symptoms similar to relapsing-remitting MS following malaria infection, leading to a diagnosis of MS. However, absence of hyperintense lesions in the brain and spinal cord presented a conundrum since not all the diagnostic criteria for MS were met. Pathology supported genetic testing (PSGT) was applied to combine family and personal medical history, lifestyle factors, and biochemical test results for interpretation of genetic findings. This approach provides a means of identifying risk factors for different subtypes of demyelinating disease. The patient was subsequently treated according to an individualised intervention program including nutritional supplementation as well as a change in diet and lifestyle. Deficiencies of vitamin B12, iron and vitamin D were addressed. Genetic analysis revealed absence of the HLA DRB1*1501 allele, considered to be the most prominent genetic risk factor for MS. Extended mutation analysis identified variations in three genes in the folate-vitamin B12 metabolic pathway, which could have increased the patient's sensitivity to the antifolate drugs used to treat the malaria. A glutathione-S-transferase GSTM1 null allele, previously associated with neurological complications of malaria, was also detected. Furthermore, a heterozygous variation in the iron-related transmembrane protease serine 6 (TMPRSS6) gene, rs855791 was found, which could have impacted the patient's iron status following two successive blood donations and exposure to malaria preceding the MS diagnosis. PSGT identifies relevant risk factors for demyelinating disorders resembling MS and uses the data for individualised treatment programs, and to systematically build a database that can provide evidence in large patient cohorts. Follow-up investigations may be suggested, such as whole exome sequencing in selected cases, to ensure that remyelination and restoration of function are achieved.
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Affiliation(s)
- Susan J van Rensburg
- Chemical Pathology, National Health Laboratory Service (NHLS) and Stellenbosch University, Cape Town, South Africa.
| | - Ronald van Toorn
- Paediatric Medicine and Child Health, Stellenbosch University, Cape Town, South Africa
| | - Kelebogile E Moremi
- Chemical Pathology, National Health Laboratory Service (NHLS) and Stellenbosch University, Cape Town, South Africa
| | - Armand V Peeters
- Anatomical Pathology, Stellenbosch University, Cape Town, South Africa
| | - Adesola Oguniyi
- Department of Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Maritha J Kotze
- Anatomical Pathology, Stellenbosch University, Cape Town, South Africa
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Acute disseminated encephalomyelitis: current controversies in diagnosis and outcome. J Neurol 2015; 262:2013-24. [DOI: 10.1007/s00415-015-7694-7] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2015] [Revised: 02/06/2015] [Accepted: 02/08/2015] [Indexed: 10/23/2022]
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Mader EC, Richeh W, Ochoa JM, Sullivan LL, Gutierrez AN, Lovera JF. Tumefactive multiple sclerosis and hepatitis C virus 2a/2C infection: Dual benefit of long-term interferon beta-1a therapy? J Neurol Sci 2015; 349:239-42. [PMID: 25575859 DOI: 10.1016/j.jns.2014.12.034] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2014] [Revised: 10/18/2014] [Accepted: 12/23/2014] [Indexed: 12/14/2022]
Abstract
Hepatitis C virus (HCV) infection has been implicated in triggering acute disseminated encephalomyelitis but not tumefactive multiple sclerosis. We report the case of a 17-year-old female who presented with a 5-day history of left hemiparesis and hemisensory loss followed by a right third nerve palsy. Tumefactive multiple sclerosis was diagnosed based on the absence of encephalopathic signs, the presence of tumefactive brain lesions, the exclusion of neoplastic and infectious causes of the lesions by biopsy, and the occurrence of relapse after a period of remission. The patient was at risk for HCV infection due to parenteral drug abuse and multiple sexual partners. Serial HCV antibody tests and RNA polymerase chain reaction assays revealed acute HCV infection and genotyping showed HCV genotype 2a/2c. She was treated with high-dose methylprednisolone and discharged with only mild left hand weakness. Interferon beta-1a 30mcg was administered intramuscularly once a week. Remission from HCV infection was achieved in three years without standard anti-HCV therapy. This case suggests that CNS myelin is a potential target of the immune response to HCV 2a/2c infection, the HCV 2a/2c virus may be involved in triggering autoimmune tumefactive brain lesions, and interferon beta-1a is effective against HCV 2a/2c infection. We recommend serial HCV antibody testing and HCV RNA PCR assay, preferably with HCV genotyping, in all patients with acute inflammatory demyelinating diseases of the CNS.
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Affiliation(s)
- Edward C Mader
- Louisiana State University Health Sciences Center, Department of Neurology, 1542 Tulane Avenue, New Orleans, LA 70112, USA.
| | - Wael Richeh
- Louisiana State University Health Sciences Center, Department of Neurology, 1542 Tulane Avenue, New Orleans, LA 70112, USA.
| | - Joaquin Maury Ochoa
- Louisiana State University Health Sciences Center, Department of Neurology, 1542 Tulane Avenue, New Orleans, LA 70112, USA.
| | - Lacey L Sullivan
- Tulane University Health Sciences, Department of Pathology and Laboratory Medicine, 1430 Tulane Avenue SL-79, New Orleans, LA 70112, USA.
| | - Amparo N Gutierrez
- Louisiana State University Health Sciences Center, Department of Neurology, 1542 Tulane Avenue, New Orleans, LA 70112, USA.
| | - Jesus F Lovera
- Louisiana State University Health Sciences Center, Department of Neurology, 1542 Tulane Avenue, New Orleans, LA 70112, USA.
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Zhang L, Wu A, Zhang B, Chen S, Men X, Lin Y, Lu Z. Comparison of deep gray matter lesions on magnetic resonance imaging among adults with acute disseminated encephalomyelitis, multiple sclerosis, and neuromyelitis optica. Mult Scler 2013; 20:418-23. [PMID: 23886831 DOI: 10.1177/1352458513499420] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Deep gray matter lesions have been reported in patients with acute disseminated encephalomyelitis (ADEM), multiple sclerosis (MS), and neuromyelitis optica (NMO). OBJECTIVES The purpose of this study was to compare the features of deep gray matter lesions on magnetic resonance imaging (MRI) among adult patients with ADEM, MS, and NMO. METHODS Ninety-five adult patients with ADEM (n=12), MS (n=60), and NMO (n=23) who had deep gray matter lesions on MRI were enrolled. Morphological features of deep gray matter lesions among these patients were assessed. RESULTS Putamen involvement was more common in patients with ADEM than in patients with MS and NMO. Differing from children, thalamus involvement might not be helpful in differentiating ADEM from MS in adults. Hypothalamus involvement was more common in patients with NMO than in patients with ADEM and MS. More importantly, bilateral hypothalamus involvement was more helpful in differentiating NMO from MS. The diameter of the thalamus lesions in patients with ADEM was larger than that in patients with NMO. CONCLUSIONS Morphological features of deep gray matter lesions vary among adult patients with ADEM, MS, and NMO, and may be helpful in distinguishing these diseases.
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Affiliation(s)
- Lei Zhang
- Department of Neurology, The Third Affiliated Hospital of Sun Yat-sen University, China
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Kageyama T, Gotoh Y, Sano F, Katoh T, Nambu M, Okada T, Suenaga T. [Diagnosis of pediatric multiple sclerosis initially presenting with tumefactive demyelinating lesion using ¹H-magnetic resonance spectroscopy]. Rinsho Shinkeigaku 2011; 51:688-693. [PMID: 21946426 DOI: 10.5692/clinicalneurol.51.688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
We report a case of tumefactive demyelinating lesion (TDL) diagnosed using (1)H-magnetic resonance spectroscopy (¹H-MRS) and conventional magnetic resonance imaging (MRI). A 7-year-old girl was admitted to our hospital with complaints of sleepiness and clumsiness of the right limbs. Neurological examination showed somnolence, right-sided apraxia, and hemiparesis with enhanced tendon reflexes and Babinski sign. Conventional brain MRI revealed extensive hyperintensity in the subcortical white matter of the left frontal lobe in both T₂ weighted and fluid attenuated inversion recovery images. Gadolinium-enhanced T₁ weighted images showed a tumor-like lesion in this area with interrupted rim enhancement, termed open ring sign, and a periventricular lesion along the inferior horn of the right lateral ventricle and a juxtacortical lesion under the right motor cortex. In ¹H-MRS, both single voxel spectroscopy (SVS) and chemical shift imaging showed elevation of choline and reduction of N-acetylaspartate in the left frontal lobe lesion. Furthermore, SVS with a short echo time revealed elevated peaks for glutamate/glutamine complex in this lesion. These results suggested the demyelinating nature of this tumor-like lesion, in accordance with the concept of TDL. Based on this diagnosis, we treated the patient with three sets of methylprednisolone pulse therapy, which resulted in the reduction of TDL and neurological improvement. A follow-up study using MRI also demonstrated two more lesions in the corona radiata and internal capsule of the left hemisphere, supporting a diagnosis of multiple sclerosis based on the revised McDonald's criteria (2010). We concluded that ¹H-MRS may be beneficial in the differential diagnosis of TDL.
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Lu Z, Zhang B, Qiu W, Kang Z, Shen L, Long Y, Huang J, Hu X. Comparative brain stem lesions on MRI of acute disseminated encephalomyelitis, neuromyelitis optica, and multiple sclerosis. PLoS One 2011; 6:e22766. [PMID: 21853047 PMCID: PMC3154259 DOI: 10.1371/journal.pone.0022766] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2011] [Accepted: 06/29/2011] [Indexed: 12/19/2022] Open
Abstract
Background Brain stem lesions are common in patients with acute disseminated encephalomyelitis (ADEM), neuromyelitis optica (NMO), and multiple sclerosis (MS). Objectives To investigate comparative brain stem lesions on magnetic resonance imaging (MRI) among adult patients with ADEM, NMO, and MS. Methods Sixty-five adult patients with ADEM (n = 17), NMO (n = 23), and MS (n = 25) who had brain stem lesions on MRI were enrolled. Morphological features of brain stem lesions among these diseases were assessed. Results Patients with ADEM had a higher frequency of midbrain lesions than did patients with NMO (94.1% vs. 17.4%, P<0.001) and MS (94.1% vs. 40.0%, P<0.001); patients with NMO had a lower frequency of pons lesions than did patients with MS (34.8% vs. 84.0%, P<0.001) and ADEM (34.8% vs. 70.6%, P = 0.025); and patients with NMO had a higher frequency of medulla oblongata lesions than did patients with ADEM (91.3% vs. 35.3%, P<0.001) and MS (91.3% vs. 36.0%, P<0.001). On the axial section of the brain stem, the majority (82.4%) of patients with ADEM showed lesions on the ventral part; the brain stem lesions in patients with NMO were typically located in the dorsal part (91.3%); and lesions in patients with MS were found in both the ventral (44.0%) and dorsal (56.0%) parts. The lesions in patients with ADEM (100%) and NMO (91.3%) had poorly defined margins, while lesions of patients with MS (76.0%) had well defined margins. Brain stem lesions in patients with ADEM were usually bilateral and symmetrical (82.4%), while lesions in patients with NMO (87.0%) and MS (92.0%) were asymmetrical or unilateral. Conclusions Brain stem lesions showed various morphological features among adult patients with ADEM, NMO, and MS. The different lesion locations may be helpful in distinguishing these diseases.
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Affiliation(s)
- Zhengqi Lu
- Department of Neurology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Bingjun Zhang
- Department of Neurology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Wei Qiu
- Department of Neurology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Zhuang Kang
- Department of Radiology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Liping Shen
- Department of Neurology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Youming Long
- Department of Neurology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Junqi Huang
- Key Laboratory of Tropical Diseases Control, Ministry of Education and Department of Immunology/Institute of Immunology, Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, China
- * E-mail: (XH); (JH)
| | - Xueqiang Hu
- Department of Neurology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
- * E-mail: (XH); (JH)
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15
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van Toorn R, Schoeman JF, Solomons R, Rensburg MA, van Rensburg SJ. Iron status in children with recurrent episodes of tumefactive cerebral demyelination. J Child Neurol 2010; 25:1401-7. [PMID: 20395637 DOI: 10.1177/0883073810366179] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Iron is a vital element in the multifactorial initiation of myelination. It is required for cholesterol and lipid biosynthesis, both key components of myelin. Iron also plays an important role in energy production by mitochondrial oxidative metabolism which occurs in myelin-producing oligodentrocytes at a higher rate than in any other cell. Iron deficiency can, therefore, result in decreased oligodendrocyte survival and defective myelination. This led us to investigate iron status in 2 consecutive children with multiple sclerosis who presented with recurrent episodes of tumefactive demyelination. Testing revealed nonanemic iron deficiency in both patients. Discontinuation of iron supplementation in both children resulted in recurrent decreased iron parameters which can indicate mutations in proteins responsible for regulation of iron uptake. Further studies are warranted to explore the association of low iron in children presenting with recurrent episodes of tumefactive demyelination.
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Affiliation(s)
- Ronald van Toorn
- Department of Pediatrics and Child Health, Tygerberg Children's Hospital Faculty of Health Sciences, Stellenbosch University, Tygerberg South Africa.
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16
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Giussani C, Poliakov A, Ferri RT, Plawner LL, Browd SR, Shaw DWW, Filardi TZ, Hoeppner C, Geyer JR, Olson JM, Douglas JG, Villavicencio EH, Ellenbogen RG, Ojemann JG. DTI fiber tracking to differentiate demyelinating diseases from diffuse brain stem glioma. Neuroimage 2010; 52:217-23. [PMID: 20363335 DOI: 10.1016/j.neuroimage.2010.03.079] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2009] [Revised: 03/20/2010] [Accepted: 03/29/2010] [Indexed: 11/29/2022] Open
Affiliation(s)
- Carlo Giussani
- Department of Neurological Surgery, University of Washington School of Medicine, Seattle Children's Hospital, Seattle, WA 98105, USA
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17
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Brinar VV, Habek M. Diagnostic imaging in acute disseminated encephalomyelitis. Expert Rev Neurother 2010; 10:459-67. [PMID: 20187866 DOI: 10.1586/ern.10.9] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Acute disseminated encephalomyelitis is an idiopathic inflammatory demyelinating disease of the CNS that is particularly difficult to differentiate from the first episode of multiple sclerosis, so called clinically isolated syndrome. Currently, no diagnostic criteria exist that could reliably differentiate these two diseases. More importantly no single clinical, neuroimaging or cerebrospinal fluid feature defines a disorder with absolute certainty. This review will summarize clinical and paraclinical characteristics of acute disseminated encephalomyelitis in adults, with special emphasis on diagnostic imaging.
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Affiliation(s)
- Vesna V Brinar
- University of Zagreb, School of Medicine and University Hospital Centre Zagreb, Department of Neurology and Referral Center for Demyelinating Diseases of the Central Nervous System, Zagreb, Croatia.
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18
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Marchioni E, Tavazzi E, Bastianello S. Non-multiple sclerosis recurrent demyelinating disorders: an ongoing debate. Brain 2010; 133:e150; author reply e151. [PMID: 20435629 DOI: 10.1093/brain/awq098] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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19
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Hu W, Lucchinetti CF. The pathological spectrum of CNS inflammatory demyelinating diseases. Semin Immunopathol 2009; 31:439-53. [PMID: 19779719 DOI: 10.1007/s00281-009-0178-z] [Citation(s) in RCA: 95] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2009] [Accepted: 08/13/2009] [Indexed: 01/09/2023]
Abstract
Inflammatory demyelinating diseases of the central nervous system (CNS) occur throughout the world and are the leading cause of nontraumatic neurological disability in young adults. They represent a broad spectrum of disorders that vary in their clinical course, regional distribution, and pathology. However, there can be a considerable overlap between at least some of these disorders, leading to misdiagnoses or diagnostic uncertainty. Multiple sclerosis (MS), the most common inflammatory demyelinating CNS disease affecting approximately one million adults, shares the basic pathological hallmark of CNS inflammatory demyelination. Advances based on recent systematic clinicopathologic-serologic correlative approaches have led to novel insights with respect to the classification of this disorder, the pathologic substrate of disability, a better understanding of the underlying pathogenic mechanisms involved in lesion formation, as well as the clinical relevance of cortical demyelination and normal appearing white matter pathology. In addition to prototypic MS, these diseases include Marburg variant of acute MS, Balo's concentric sclerosis, neuromyelitis optica, acute disseminated encephalomyelitis, and tumefactive MS. The last decade has seen a resurgence of interest in examining the lesions of these inflammatory demyelinating CNS disorders with newer and more sophisticated immunological and molecular tools. Herein, we review the clinicopathologic features of these CNS inflammatory demyelinating disorders and discuss recent advances in understanding their immunopathogenesis.
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Affiliation(s)
- Wei Hu
- Department of Neurology, Mayo Clinic College of Medicine, Rochester, MN 55905, USA
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20
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Xia L, Lin S, Wang ZC, Li SW, Xu L, Wu J, Hao SY, Gao CC. Tumefactive demyelinating lesions: nine cases and a review of the literature. Neurosurg Rev 2009; 32:171-9; discussion 179. [PMID: 19172322 DOI: 10.1007/s10143-009-0185-5] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2008] [Revised: 11/08/2008] [Accepted: 12/06/2008] [Indexed: 12/27/2022]
Abstract
Tumefactive demyelinating lesions (TDLs) are misdiagnosed frequently. To investigate the characteristics of TDLs, clinical and radiological data from nine cases with TDLs were analyzed after admission. All cases underwent surgery and pathological examination; some received postoperative steroid therapy. Onsets were mostly within 3 weeks and main presentation included intracranial hypertension, extremity weakness, epilepsy, and visual disturbance. Symptoms in children were acute and severe, frequently including headache, vomiting, and visual disturbance. Most intracephalic lesions were in cerebral hemispheres. All intraspinal lesions were in cervical segments. Radiological features included mass effect, perifocal edema and enhancement (of which open-ring enhancement was diagnostic), and decreased relative cerebral blood volume. Intraoperative frozen section did not confirm the diagnosis, while postoperative paraffin section did confirm it (by evidence of macrophage infiltration). The patients responded well to steroid therapy and no relapse was found during following up. Thus, intensive analysis of both clinical and radiological data may provide some clues for diagnosis. For suspected cases, it is advisable to take steroid therapy or undergo advanced radiological examinations, such as serial magnetic resonance spectroscopy. However, in difficult cases, pathological evidence is beneficial to a final diagnosis.
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Affiliation(s)
- Lei Xia
- Beijing Neurosurgical Institute, Capital Medical University, Beijing, 100050, China
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21
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Brinar VV, Poser CM. Disseminated encephalomyelitis in adults. Clin Neurol Neurosurg 2008; 110:913-8. [DOI: 10.1016/j.clineuro.2008.06.015] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2008] [Accepted: 06/12/2008] [Indexed: 11/24/2022]
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22
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Tenembaum SN. Disseminated encephalomyelitis in children. Clin Neurol Neurosurg 2008; 110:928-38. [PMID: 18272282 PMCID: PMC7116932 DOI: 10.1016/j.clineuro.2007.12.018] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2007] [Revised: 11/15/2007] [Accepted: 12/19/2007] [Indexed: 11/09/2022]
Abstract
The advent of MRI has contributed to increase the interest and awareness in childhood white matter disorders. A major priority is to distinguish transient and self-limited demyelinating syndromes like disseminated encephalomyelitis (DEM), from life-long diseases like multiple sclerosis (MS). However, the term DEM has been inconsistently applied across studies due to the lack of clear clinical and neuroimaging diagnostic criteria. The present review summarizes the available literature on DEM in children, outlines the main clinical and neuroimaging features at presentation, pathogenesis and outcome, and its differentiation from other conditions with acute impact in the CNS. The recently proposed clinical definitions for monophasic disseminated encephalomyelitis and its relapsing variants are discussed, and controversies surrounding the diagnosis of MS in children are addressed.
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Affiliation(s)
- Silvia N Tenembaum
- Department of Neurology, National Paediatric Hospital Dr. J. P. Garrahan, Buenos Aires, Argentina.
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23
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Brinar VV, Habek M, Zadro I, Barun B, Ozretić D, Vranješ D. Current concepts in the diagnosis of transverse myelopathies. Clin Neurol Neurosurg 2008; 110:919-27. [DOI: 10.1016/j.clineuro.2008.07.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2008] [Revised: 07/01/2008] [Accepted: 07/02/2008] [Indexed: 10/21/2022]
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24
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Lucchinetti CF, Gavrilova RH, Metz I, Parisi JE, Scheithauer BW, Weigand S, Thomsen K, Mandrekar J, Altintas A, Erickson BJ, König F, Giannini C, Lassmann H, Linbo L, Pittock SJ, Brück W. Clinical and radiographic spectrum of pathologically confirmed tumefactive multiple sclerosis. Brain 2008; 131:1759-75. [PMID: 18535080 PMCID: PMC2442427 DOI: 10.1093/brain/awn098] [Citation(s) in RCA: 311] [Impact Index Per Article: 19.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Atypical imaging features of multiple sclerosis lesions include size >2 cm, mass effect, oedema and/or ring enhancement. This constellation is often referred to as ‘tumefactive multiple sclerosis’. Previous series emphasize their unifocal and clinically isolated nature, however, evolution of these lesions is not well defined. Biopsy may be required for diagnosis. We describe clinical and radiographic features in 168 patients with biopsy confirmed CNS inflammatory demyelinating disease (IDD). Lesions were analysed on pre- and post-biopsy magnetic resonance imaging (MRI) for location, size, mass effect/oedema, enhancement, multifocality and fulfilment of Barkhof criteria. Clinical data were correlated to MRI. Female to male ratio was 1.2 : 1, median age at onset, 37 years, duration between symptom onset and biopsy, 7.1 weeks and total disease duration, 3.9 years. Clinical course prior to biopsy was a first neurological event in 61%, relapsing–remitting in 29% and progressive in 4%. Presentations were typically polysymptomatic, with motor, cognitive and sensory symptoms predominating. Aphasia, agnosia, seizures and visual field defects were observed. At follow-up, 70% developed definite multiple sclerosis, and 14% had an isolated demyelinating syndrome. Median time to second attack was 4.8 years, and median EDSS at follow-up was 3.0. Multiple lesions were present in 70% on pre-biopsy MRI, and in 83% by last MRI, with Barkhof criteria fulfilled in 46% prior to biopsy and 55% by follow-up. Only 17% of cases remained unifocal. Median largest lesion size on T2-weighted images was 4 cm (range 0.5–12), with a discernible size of 2.1 cm (range 0.5–7.5). Biopsied lesions demonstrated mass effect in 45% and oedema in 77%. A strong association was found between lesion size, and presence of mass effect and/or oedema (P< 0.001). Ring enhancement was frequent. Most tumefactive features did not correlate with gender, course or diagnosis. Although lesion size >5 cm was associated with a slightly higher EDSS at last follow-up, long-term prognosis in patients with disease duration >10 years was better (EDSS 1.5) compared with a population-based multiple sclerosis cohort matched for disease duration (EDSS 3.5; P< 0.001). Given the retrospective nature of the study, the precise reason for biopsy could not always be determined. This study underscores the diagnostically challenging nature of CNS IDDs that present with atypical clinical or radiographic features. Most have multifocal disease at onset, and develop RRMS by follow-up. Although increased awareness of this broad spectrum may obviate need for biopsy in many circumstances, an important role for diagnostic brain biopsy may be required in some cases.
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Affiliation(s)
- C F Lucchinetti
- Department of Neurology, College of Medicine, Mayo Clinic, 200 First St SW, Rochester, MN 55905, USA
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25
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Beyer AM, Wandinger KP, Siebert E, Zschenderlein R, Klehmet J. Neuromyelitis optica in a patient with an early onset demyelinating episode: clinical and autoantibody findings. Clin Neurol Neurosurg 2008; 109:926-30. [PMID: 17913344 DOI: 10.1016/j.clineuro.2007.08.018] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2007] [Revised: 08/14/2007] [Accepted: 08/18/2007] [Indexed: 11/19/2022]
Abstract
Recent clinical and laboratory findings have substantially advanced our understanding of neuromyelitis optica (NMO) as a humorally mediated, autoimmune disorder. We report on a patient who suffered a first episode of transverse myelitis at the age of 6 months following diphtheria-pertussis-tetanus (DPT) vaccination which had therefore been considered suggestive of acute disseminated encephalomyelitis (ADEM). Fifteen years later, the further disease course revealed typical NMO meeting all diagnostic criteria. This development points to a broad clinical and temporal heterogeneity of NMO, with ADEM probably occurring in the context of a shared autoimmune diathesis. Despite therapy response following B-cell depletion by rituximab, positive NMO-IgG autoantibody status remained unchanged, whereas direct testing for anti-aquaporin-4 (AQP-4)-antibodies was negative throughout. Our findings challenge the pathogenic relevance of NMO-IgG and indicate a varying diagnostic value of testing for NMO-IgG and AQP-4-autoantibodies.
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Affiliation(s)
- Anja-Maria Beyer
- Department of Neurology, Charité-University Medicine, Charitéplatz 1, 10117 Berlin, Germany
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26
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Poser CM. Treating clinically isolated syndromes suggestive of MS. Lancet 2007; 370:2000; author reply 2000-1. [PMID: 18083395 DOI: 10.1016/s0140-6736(07)61854-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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27
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Spirovski M, Kozić D, Kopitović A, Ostojić J. Importance of axial postcontrast images in the differential diagnosis between inflammatory and neoplastic spinal cord enlargement. Clin Neurol Neurosurg 2007; 109:931-3. [PMID: 17868981 DOI: 10.1016/j.clineuro.2007.07.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2007] [Revised: 07/19/2007] [Accepted: 07/21/2007] [Indexed: 11/17/2022]
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28
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Poser CM, Brinar VV. The Accuracy of Prevalence Rates of Multiple Sclerosis: A Critical Review. Neuroepidemiology 2007; 29:150-5. [DOI: 10.1159/000111576] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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29
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Poser CM, Brinar VV. Disseminated encephalomyelitis and multiple sclerosis: two different diseases - a critical review. Acta Neurol Scand 2007; 116:201-6. [PMID: 17824894 DOI: 10.1111/j.1600-0404.2007.00902.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The practice of initiating immunomodulatory treatment immediately after a clinically isolated syndrome (CIS) suggestive of multiple sclerosis (MS) emphasizes the need to distinguish between disseminated encephalomyelitis (DEM) and MS. Their clinical, genetic, imaging, and histopathological characteristics establish that they are distinct disease entities. Acute and recurrent DEM are more common in children, but also occur in adults. DEM is polysymptomatic and includes signs and symptoms rarely encountered in MS, such as fever, alterations of the state of consciousness, cognitive and aphasic symptoms, and meningism. Cerebrospinal oligoclonal bands are rare. Magnetic resonance imaging (MRI) is the best means of distinguishing between DEM and MS. In the former, the lesion load is heavy, thalamus or basal ganglia are often affected, and early in the disease most of the lesions are usually larger than those of MS and enhance with gadolinium. The MRI spinal cord lesions are longer than three vertebral segments, and define neuromyelitis optica (NMO). Antibodies against aquaporin-4 are present in some NMO, but are also found in cases of MS and DEM. Most NMO are forms of DEM, not MS, and are identical with the 'Oriental' or 'optico-spinal' form of MS.
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Affiliation(s)
- C M Poser
- Department of Neurology, Harvard Medical School, Boston, MA, USA.
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30
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Mowry EM, Woo JH, Ances BM. Baló's concentric sclerosis presenting as a stroke-like syndrome. ACTA ACUST UNITED AC 2007; 3:349-54. [PMID: 17549061 DOI: 10.1038/ncpneuro0522] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2007] [Accepted: 03/23/2007] [Indexed: 01/09/2023]
Abstract
BACKGROUND A 37-year-old woman without important previous medical history presented to an emergency room with acute onset of left-sided weakness and numbness. Examination revealed left-sided hemiparesis (in the arm greater than in the leg) and hypoesthesia. INVESTIGATIONS Routine laboratory testing, lumbar puncture, dynamic susceptibility contrast perfusion study, longitudinal brain MRI, and magnetic resonance spectroscopy were performed. DIAGNOSIS Balós concentric sclerosis. MANAGEMENT Intravenous methylprednisolone followed by oral steroid taper.
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Affiliation(s)
- Ellen M Mowry
- Department of Neurology, University of Pennsylvania, Philadelphia, PA, USA
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31
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Mowry EM, Woo JH, Ances BM. Technology insight: can neuroimaging provide insights into the role of ischemia in Baló's concentric sclerosis? ACTA ACUST UNITED AC 2007; 3:341-8. [PMID: 17549060 DOI: 10.1038/ncpneuro0519] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2007] [Accepted: 03/22/2007] [Indexed: 12/21/2022]
Abstract
Baló's concentric sclerosis (BCS) has long been considered to be a variant of multiple sclerosis. Although BCS was initially described over 100 years ago, relatively few antemortem cases have been identified, and the exact pathogenesis remains unknown. Inflammatory protective ischemic preconditioning has recently been suggested as a mechanism by which the typical concentric rings of the BCS lesion are formed. Advanced neuroimaging can provide important in vivo markers of disease progression that can assist in the diagnosis and management of patients with BCS. In this Review, we discuss evidence from longitudinal neuroimaging studies that supports the role of ischemic preconditioning in BCS.
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Affiliation(s)
- Ellen M Mowry
- Department of Neurology, University of Pennsylvania, Philadelphia, PA, USA
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32
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Wiendl H, Kieseier BC, Gold R, Hohlfeld R, Bendszus M, Hartung HP. [Revision of McDonald's new diagnostic criteria for multiple sclerosis]. DER NERVENARZT 2007; 77:1235, 1237-45. [PMID: 16912904 DOI: 10.1007/s00115-006-2127-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
In 2001, an international panel suggested new diagnostic criteria for multiple sclerosis (MS). These criteria integrate clinical, imaging (MRI), and paraclinical results in order to facilitate diagnosis. Since then, these so-called McDonald criteria have been broadly accepted and widely propagated. In the meantime a number of publications have dealt with the sensitivity and specificity for MS diagnosis and with implementing these new criteria in clinical practice. Based on these empirical values and newer data on MS, an international expert group recently proposed a revision of the criteria. Substantial changes affect (1) MRI criteria for the dissemination of lesions over time, (2) the role of spinal cord lesions in the MRI and (3) diagnosis of primary progressive MS. In this article we present recent experiences with the McDonald and revised criteria.
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Affiliation(s)
- H Wiendl
- Neurologische Klinik und Poliklinik, Julius-Maximilians-Universität, Würzburg
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33
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Cañellas AR, Gols AR, Izquierdo JR, Subirana MT, Gairin XM. Idiopathic inflammatory-demyelinating diseases of the central nervous system. Neuroradiology 2007; 49:393-409. [PMID: 17333161 DOI: 10.1007/s00234-007-0216-2] [Citation(s) in RCA: 82] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2006] [Accepted: 01/18/2007] [Indexed: 01/18/2023]
Abstract
Idiopathic inflammatory-demyelinating diseases (IIDDs) include a broad spectrum of central nervous system disorders that can usually be differentiated on the basis of clinical, imaging, laboratory and pathological findings. However, there can be a considerable overlap between at least some of these disorders, leading to misdiagnoses or diagnostic uncertainty. The relapsing-remitting and secondary progressive forms of multiple sclerosis (MS) are the most common IIDDs. Other MS phenotypes include those with a progressive course from onset (primary progressive and progressive relapsing) or with a benign course continuing for years after onset (benign MS). Uncommon forms of IIDDs can be classified clinically into: (1) fulminant or acute IIDDs, such as the Marburg variant of MS, Baló's concentric sclerosis, Schilder's disease, and acute disseminated encephalomyelitis; (2) monosymptomatic IIDDs, such as those involving the spinal cord (transverse myelitis), optic nerve (optic neuritis) or brainstem and cerebellum; and (3) IIDDs with a restricted topographical distribution, including Devic's neuromyelitis optica, recurrent optic neuritis and relapsing transverse myelitis. Other forms of IIDD, which are classified clinically and radiologically as pseudotumoral, can have different forms of presentation and clinical courses. Although some of these uncommon IIDDs are variants of MS, others probably correspond to different entities. MR imaging of the brain and spine is the imaging technique of choice for diagnosing these disorders, and together with the clinical and laboratory findings can accurately classify them. Precise classification of these disorders may have relevant prognostic and treatment implications, and might be helpful in distinguishing them from tumoral or infectious lesions, avoiding unnecessary aggressive diagnostic or therapeutic procedures.
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Affiliation(s)
- A Rovira Cañellas
- Magnetic Resonance Unit (I.D.I.), Department of Radiology, Vall d'Hebron University Hospital, Pg. Vall d'Hebron 119-129, Barcelona 08035, Spain.
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34
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Ordonez L, Skromne E, Ontaneda D, Rivera VM. Multiphasic disseminated encephalomyelitis, systemic lupus erythematosus and antiphospholipid syndrome. Clin Neurol Neurosurg 2007; 109:102-5. [PMID: 16624483 DOI: 10.1016/j.clineuro.2006.03.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2006] [Revised: 03/13/2006] [Accepted: 03/15/2006] [Indexed: 11/20/2022]
Abstract
We report a case of multiphasic disseminated encephalomyelitis (MDEM) associated with systemic lupus erythematosus (SLE) and antiphospholipid syndrome. The initial presentation was suggestive of multiple sclerosis. Further clinical attacks, MRI imaging, and CSF findings led to a diagnosis of disseminated encephalomyelitis (DEM). Multiple episodes of neurological dysfunction, which differed in clinical presentation, further categorized the diagnosis as multiphasic DEM. The co-occurrence SLE and antiphospholipid syndrome is unusual and provided an additional diagnostic challenge.
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Affiliation(s)
- Laura Ordonez
- Maxine Mesinger MS Clinic, Department of Neurology, Baylor College of Medicine, Houston, TX 77030, USA.
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35
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Demirkiran M, özeren A, Bozdemir H. Letter to the Editor. Mult Scler 2006. [DOI: 10.1191/135248506ms1354xx] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- M Demirkiran
- Department of Neurology, School of Medicine, Ç ukurova University, Adana, Turkey
| | - A özeren
- Department of Neurology, School of Medicine, çukurova University, Adana, Turkey
| | - H Bozdemir
- Department of Neurology, School of Medicine, Ç ukurova University, Adana, Turkey
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36
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37
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38
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Habek M, Brinar M, Brinar VV, Poser CM. Psychiatric manifestations of multiple sclerosis and acute disseminated encephalomyelitis. Clin Neurol Neurosurg 2006; 108:290-4. [PMID: 16364539 DOI: 10.1016/j.clineuro.2005.11.024] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
It is unusual for acute disseminated encephalomyelitis and multiple sclerosis to present as purely psychiatric disorders. We report five patients with such demyelinating diseases and symptoms of psychosis, depression or anxiety. The importance of excluding demyelination as the basis for these psychiatric disturbances is emphasized, especially in the presence of unexplained neurologic findings. The possible relationship between psychiatric symptoms and demyelinating disorders is explored.
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Affiliation(s)
- Mario Habek
- University Department of Neurology, Zagreb School of Medicine and University Hospital Center Zagreb, Kispatićeva 12, Zagreb, Croatia.
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39
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Affiliation(s)
- Vesna V Brinar
- University Department of Neurology, Zagreb School of Medicine and University Hospital Center, Kispatićeva 12, Zagreb, Croatia.
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40
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Brinar M, Rados M, Habek M, Poser CM. Enlargement of the spinal cord: inflammation or neoplasm? Clin Neurol Neurosurg 2005; 108:284-9. [PMID: 16376015 DOI: 10.1016/j.clineuro.2005.11.023] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Intramedullary spinal tumours are uncommon lesions that can cause significant difficulties in the differential diagnosis between inflammatory diseases such as multiple sclerosis and acute disseminated encephalomyelitis, and vascular malformations or neoplasms. We report five cases in which the history and the clinical symptoms suggested an inflammatory process of the spinal cord but the MRI characteristics were those of neoplastic lesions. Both non-neoplastic and neoplastic intramedullary lesion may have very similar symptoms, and even CSF abnormalities, but in every one of our cases, a more detailed history and longer observation of the clinical course would have led to the correct diagnosis; in such problem cases, empirical treatment and a follow-up MRI after a month's observation would be a more prudent approach providing that the patient is not rapidly deteriorating.
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Affiliation(s)
- Marko Brinar
- University Department of Internal Medicine, Zagreb School of Medicine and University Hospital Center, Kispatićeva 12, Zagreb, Croatia.
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Poser CM. Pseudo-tumoral multiple sclerosis. Clin Neurol Neurosurg 2005; 107:535. [PMID: 15925441 DOI: 10.1016/j.clineuro.2005.04.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2005] [Accepted: 04/24/2005] [Indexed: 10/25/2022]
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