Progressive multifocal leukoencephalopathy in a patient with relapsing multiple sclerosis treated with ocrelizumab: A case report

INTRODUCTION

Progressive multifocal leukoencephalopathy is a rare but often fatal complication of some multiple sclerosis treatments. Although it has mainly been associated with natalizumab treatment, its appearance with other immunosuppressive therapies has also been reported.

AIMS

The aim of this case report is to describe the development of progressive multifocal encephalopathy in a patient with relapsing-remitting multiple sclerosis treated with ocrelizumab without previous use of natalizumab.

CONCLUSIONS

A summary of the presentation and disease course is provided, presented in the context of the current literature and likely pathophysiology.

Wallerian degeneration in the corticospinal tract evaluated by diffusion tensor imaging correlates with motor deficit 30 days after middle cerebral artery ischemic stroke

BACKGROUND AND PURPOSE

The quantification and clinical significance of WD in CSTs following supratentorial stroke are not well understood. We evaluated the anisotropy by using DTI and signal-intensity changes on conventional MR imaging in the CST to determine whether these findings are correlated with limb motor deficit in patients with MCA ischemic stroke.

MATERIALS AND METHODS

We studied 60 patients within 12 hours of stroke onset. At admission, day 3, and day 30 of evolution, patients underwent multimodal MR imaging, including DTI sequences. We assessed the severity of limb weakness by using the motor subindex scores (5a, 5b, 6a, 6b) of the m-NIHSS and established 3 groups: I (m-NIHSS scores of 0), II (m-NIHSS, 1-4), and III (m-NIHSS, 5-8). FA values and rFAs were measured on the affected and the unaffected CSTs in the pons.

RESULTS

FA values for the CST were significantly lower on the affected side compared with the unaffected side only at day 30 (P < .001), and the rFA was significantly correlated with the motor deficit at day 30 (P < .001; r = -0.793). The sensitivity, specificity, and positive and negative predictive values for motor deficit by rFA < 0.925 were 95.2%, 94.9%, 90.9%, and 97.4%, respectively.

CONCLUSIONS

WD in the CST revealed by DTI correlates with motor deficit 30 days after MCA ischemic stroke. This study highlights the utility of imaging follow-up at 30 days and the potential of DTI as a surrogate marker in clinical trials.

Magnetic resonance imaging in the diagnosis of stroke

BACKGROUND

The high morbidity and mortality of strokes result in enormous costs to our society. In the last decade advanced imaging techniques with high sensitivity in the diagnosis of acute stroke have been developed. Acute thrombolytic treatment beyond 3 h of acute stroke duration requires the demonstration of penumbra or 'tissue at risk'. However, the utility of the mismatch concept to identify the penumbra area is controversial.

OBJECTIVE

The aim is to describe the main features of acute stroke on magnetic resonance imaging.

METHOD

Information was obtained from a search of the PubMed and Medline databases (keywords: imaging, stroke, diagnosis and infarct) for articles published from 1997.

CONCLUSION

To conclude, new imaging biomarkers of relevant mismatch, hemorrhagic transformation and worse outcome should be developed in the future.