Imaging in Multiple sclerosis
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This document discusses the typical MRI findings seen in multiple sclerosis (MS). Key findings include ovoid lesions perpendicular to the ventricles known as Dawson fingers, enhancing lesions, and multiple lesions adjacent to the ventricles. Enhancement is seen for about a month after a lesion occurs. Juxtacortical lesions touching the cortex and involvement of the temporal lobe, corpus callosum, and periventricular regions are also typical of MS. Multiple lesions can be seen in the spinal cord, most often in the cervical region. Several variants of MS are also mentioned, including tumefactive MS, Balo's concentric sclerosis, and neuromyelitis optica, which is now considered a distinct
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Multiple sclerosis: Introduction, Risk Factors, Diagnosis and Treatment
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1. The document discusses various white matter disorders that can be seen on MRI imaging. It focuses on demyelinating diseases like multiple sclerosis (MS), neuromyelitis optica (NMO), acute disseminated encephalomyelitis (ADEM), and other related conditions.
2. MS is characterized by well-defined white matter lesions that are often ovoid or perpendicular to the ventricles. Lesions can also be seen in the corpus callosum, brainstem, spinal cord, and optic nerves. MRI is important for diagnosis and monitoring of MS.
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Spinal myelopathy
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Multiple Sclerosis MS(lecture)abcd.pptx
Multiple sclerosis is a disease that destroys myelin in the central nervous system. It most commonly affects people between 20-40 years old. The disease has an uneven global distribution and both genetic and environmental factors influence risk. Symptoms vary depending on location of lesions in the brain and spinal cord but may include visual issues, motor problems, sensory changes, and more. The disease typically follows a relapsing-remitting course with exacerbations followed by periods of remission or stabilization. Diagnosis involves ruling out other possibilities and may include MRI, lumbar puncture, and examination of symptoms and clinical course.
Short case...Multiple sclerosis
This document summarizes an MRI study of a 40-year-old female patient with multiple sclerosis. The MRI shows lesions throughout the brain characteristic of multiple sclerosis, including periventricular lesions and lesions perpendicular to the ventricles. Some lesions enhance with contrast, indicating active inflammation, while others do not, representing chronic inactive lesions. The MRI findings of disseminated lesions in both time and space support a diagnosis of chronic multiple sclerosis.
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MRI is a key investigation for differentiating between multiple sclerosis (MS) and other diseases that can mimic MS. This document discusses various approaches to differentiating MS from mimics based on MRI findings, including examining pathology, red flags, and specific imaging characteristics.
Numerous conditions are reviewed that can appear similar to MS on MRI, such as small vessel disease, migraines, Susac syndrome, CADASIL, CAA, inflammatory conditions, infections, metabolic/toxin disorders, trauma, tumors, and leukodystrophies. Each condition has distinguishing imaging features, such as lesion location, enhancement patterns, involvement of specific structures, and evolution over time. Careful analysis of the MRI according to the
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This document provides an overview of multiple sclerosis (MS), including its causes, pathophysiology, clinical features, diagnosis, course, classifications, and the role of MR imaging. MS is a demyelinating disease of the central nervous system that typically affects people aged 20-40. It has an unknown cause but is thought to involve genetic, viral, autoimmune, and environmental factors. Clinically, it presents with sensory issues, optic neuritis, spasticity, and other symptoms. Diagnosis involves identifying neurological abnormalities via history, exam, and MRI findings. The disease course is highly variable but can be classified as relapsing-remitting, secondary-progressive, primary-progressive, or progressive-
Overview & role of imaging of ms
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Common disorders misdiagnosed as ms
The document discusses the importance of carefully considering alternative diagnoses to multiple sclerosis (MS) when evaluating patients. Common causes of MS misdiagnosis include nonspecific white matter abnormalities on brain MRI and vague neurological symptoms. Other disorders like neuromyelitis optica spectrum disorders, acute disseminated encephalomyelitis, and inherited disorders can mimic MS clinically and radiologically. A thorough evaluation of demographic, clinical, laboratory, and imaging factors is necessary to avoid misdiagnosis, as an MS diagnosis has significant implications for treatment.
Case record... Multiple sclerosis
This document summarizes an MRI case study of a patient with multiple sclerosis. The MRI images show:
- Multiple oval or rounded lesions that are hypointense on T1-weighted images and hyperintense on T2-weighted and FLAIR images, with some lesions perpendicular to the ventricles characteristic of MS.
- Some lesions show ring enhancement on post-contrast T1 images, indicating dissemination in time with both active and chronic components.
- Based on the widespread lesions distributed in both space and time seen on MRI, the diagnosis is chronic multiple sclerosis in exacerbation.
Tuberous sclerosis
Tuberous sclerosis complex (TSC) is a genetic disorder characterized by benign tumors that develop in many organs, including the brain, eyes, heart, lungs, kidneys and skin. It is caused by mutations in either the TSC1 or TSC2 gene. Major features seen on imaging include cortical tubers, subependymal nodules, and subependymal giant cell astrocytomas. These lesions appear at specific locations and with characteristic appearances on CT and MRI scans that are useful for diagnosis. Treatment may involve medication or surgery depending on the impact of the lesions.
Presentation1.pptx,radiological imaging of cord myelopathy.
This document discusses radiological imaging of myelopathy, or spinal cord damage and dysfunction. It describes various causes of myelopathy including traumatic injuries, vascular diseases, infections, tumors, and inflammatory/autoimmune processes. It provides detailed information on imaging features and classifications of different types of myelopathy, such as compressive myelopathy from degeneration, trauma, abscesses, tumors, syringomyelia, and transverse myelitis. The document emphasizes the importance of imaging such as MRI in diagnosing myelopathy and guiding treatment.
Non Traumatic Spinal cord injuries
1. Spinal cord injuries and diseases can be traumatic due to external forces or non-traumatic due to underlying conditions. Common non-traumatic diseases include tumors, infections, inflammation, and vascular abnormalities.
2. Assessment involves evaluating neurological function, imaging like MRI to identify abnormalities, and diagnostic tests like lumbar puncture. Management depends on the specific condition but may require surgery, antibiotics, steroids, or other treatments.
3. Outcomes depend on the level and completeness of injury, with earlier treatment often leading to better recovery of function. Quality of life is significantly impacted due to paralysis and other functional limitations.
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Imaging in Multiple sclerosis
- 4. DAWSON FINGERS Typical findings for MS are: • ovoid lesions perpendicular to the ventricles (dawson fingers). • enhancing lesion. • multiple lesions adjacent to the ventricles. • Dawson fingers are typical for MS and are the result of inflammation around penetrating venules. These veins are perpendicular to the ventricular surface. • ENHANCEMENT is another typical finding in MS. This enhancement will be present for about one month after the occurrence of a lesion. The simultaneous demonstration of enhancing and non-enhancing lesions in MS is the radiological counterpart of the clinical dissemination in time and space. The edema will regress and finally only the center will remain as a hyperintense lesion on t2wi.
- 5. • Most incidentally found WMLS will have a vascular origin.
- 6. TYPICAL MRI FINDINGS FAVORING MS Typical differences in vascular brainstem lesions compared to ms The image on the left is an axial T2 weighted image illustrating typical vascular brainstem involvement, with a central involvement of the transverse pontine fibers. The image on the right is an axial T2 weighted image of the brainstem of an MS-patient, showing typical peripherally located white matter lesions, often in or near the trigeminal tract, or bordering the 4th ventricle.
- 7. Typical for MS in this case is: • Involvement of the temporal lobe (red arrow) • Juxtacortical lesions (green arrow) - touching the cortex • Involvement of the corpus callosum (blue arrow) • Periventricular lesions - touching the ventricles
- 8. Juxtacortical lesions - specific for MS. • Adjacent to the cortex and must touch the cortex. • Do not use the word subcortical to describe this location, because that is a less specific term, indicating a larger area of white matter almost reaching the ventricles. • In small vessel disease these juxtacortical U-fibers are not involved and on T2 and FLAIR there will be a dark band between the WML and the (also bright) cortex (yellow arrow). Temporal lobe involvement is also specific for MS. In hypertensive encephalopathy, the WMLs are located in the frontal and parietal lobes, uncommonly in the occipital lobes and not in the temporal lobes. Only in CADASIL there is early involvement of the temporal lobes.
- 9. • There are multiple lesions in the spinal cord. another typical feature of MS. • Typical spinal cord lesions in ms are relatively small and peripherally located. • They are most often found in the cervical cord and are usually less than 2 vertebral segments in length. a spinal cord lesion together with a lesion in the cerebellum or brainstem is very suggestive of MS. • Spinal cord lesions are uncommon in most other CNS diseases, with the exception of ADEM, Sarcoid, Lyme disease and SLE. • Proton density weighted image (PDWI).they are crucial for studying the spinal cord. On PDW-IMAGES the spinal cord has a uniformly low signal intensity (like CSF), which gives the ms lesions a good contrast against the surrounding csf and normal cord tissue.
- 14. DIFFERENTIAL DIAGNOSIS FOR MULTIPLE SCLEROSIS ADEM
- 23. MULTIPLE SCLEROSIS Multiple sclerosis (MS) is a relatively common acquired chronic relapsing demyelinating disease involving the central nervous system, and is the second most common cause of neurological impairment in young adults, after trauma. characteristically, and by definition, multiple sclerosis is disseminated not only in space (i.e multiple lesions in different regions of the brain) but also in time (i.e. lesions occur at different times). A number of clinical variants are recognised : • classic multiple sclerosis (charcot type) • Tumefactive multiple sclerosis • Marburg type (acute malignant) • Schilder type (diffuse cerebral sclerosis) • Balo concentric sclerosis • IMPORTANTLY, neuromyelitis optica (devic disease) was considered a variant of multiple sclerosis, but is now recognised as a distinct entity
- 24. THANK YOU