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-
This document discusses white matter diseases of the central nervous system, including multiple sclerosis and other demyelinating diseases. It covers ICD10 classifications, metabolic disorders, infections, tumors, trauma, and vascular causes that can lead to white matter lesions. MRI is an important tool for the diagnosis and monitoring of multiple sclerosis, with findings like lesions greater than 6mm or lesions oriented perpendicular to ventricles providing supportive evidence for MS. Lesion location, extent, and pathology seen on different MRI sequences can provide prognostic information, though correlation with disability is complex.
MRI is the gold standard for diagnosing multiple sclerosis (MS). It can detect focal demyelinating lesions appearing as hyperintense areas on T2-weighted MRI. Different MRI sequences like T1, T2, FLAIR, and gadolinium contrast help identify lesions at various stages. MS lesions typically occur in periventricular white matter, corpus callosum, brainstem, and spinal cord. Advanced MRI techniques like MTR, DTI, and MRS provide additional insights into MS pathology by detecting subtle tissue damage. MRI plays a key role in the diagnostic criteria for MS by demonstrating dissemination of lesions in space and time. It is also used as an outcome measure in clinical trials to monitor
MRI differential diagnosis of Multiple sclerosissrimantp
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
Neuroradiology in multiple sclerosis
MRI in diagnosis of MS
MRI in D.D. of MS
MRI in monitoring disease progression and response to DMT
New imaging techniques
This document summarizes multiple sclerosis (MS), a chronic inflammatory demyelinating disease of the central nervous system. It discusses the etiology, pathology, clinical presentation, imaging features, diagnostic criteria, variants, and differential diagnosis of MS. Key points include: MS is characterized by inflammatory demyelinating lesions ("plaques") in the brain and spinal cord; risk factors include genetic and environmental factors; clinical presentation varies from relapsing-remitting to progressive forms; MRI is important for diagnosis and demonstrates disseminated hyperintense lesions; and differential diagnosis includes ADEM, Susac syndrome, and CNS tumors.
This document discusses remyelinating therapies for multiple sclerosis (MS). It begins by explaining how MS results in demyelination and how remyelination can restore neuronal function. Several potential remyelinating therapies currently in preclinical or clinical trials are described, including clobetasol, opicinumab, guanabenz, and olesoxime. Biomarkers for measuring remyelination like diffusion tensor imaging, magnetization transfer imaging, and positron emission tomography are also summarized. The document concludes that while challenges remain, promising remyelinating strategies exist to provide benefit throughout the entire course of MS.
1) MRI is useful for diagnosing and monitoring multiple sclerosis (MS). Common MRI findings in MS include ovoid lesions perpendicular to ventricles that appear as high signal on T2-weighted and FLAIR images.
2) Different MS subtypes have distinct clinical patterns. Relapsing-remitting MS (RRMS) accounts for 58% of cases and is characterized by neurological symptoms lasting over 24 hours followed by complete or partial recovery with intervals of at least one month between relapses.
3) Optimal MRI protocols for evaluating MS include 3D FLAIR, DIR, and SWI sequences which can help detect cortical and subclinical lesions. Monitoring for contrast enhancing lesions on post-g
This presentation provides an overview of demyelinating diseases, focusing on multiple sclerosis (MS). It defines demyelinating diseases as those that cause myelin destruction while sparing other nervous system elements. MS is described as an autoimmune, inflammatory demyelinating disease of the central nervous system (CNS) that is more common in women. The presentation covers the pathology, clinical features, investigations, and treatment approaches for MS.
This document discusses white matter diseases of the central nervous system, including multiple sclerosis and other demyelinating diseases. It covers ICD10 classifications, metabolic disorders, infections, tumors, trauma, and vascular causes that can lead to white matter lesions. MRI is an important tool for the diagnosis and monitoring of multiple sclerosis, with findings like lesions greater than 6mm or lesions oriented perpendicular to ventricles providing supportive evidence for MS. Lesion location, extent, and pathology seen on different MRI sequences can provide prognostic information, though correlation with disability is complex.
MRI is the gold standard for diagnosing multiple sclerosis (MS). It can detect focal demyelinating lesions appearing as hyperintense areas on T2-weighted MRI. Different MRI sequences like T1, T2, FLAIR, and gadolinium contrast help identify lesions at various stages. MS lesions typically occur in periventricular white matter, corpus callosum, brainstem, and spinal cord. Advanced MRI techniques like MTR, DTI, and MRS provide additional insights into MS pathology by detecting subtle tissue damage. MRI plays a key role in the diagnostic criteria for MS by demonstrating dissemination of lesions in space and time. It is also used as an outcome measure in clinical trials to monitor
MRI differential diagnosis of Multiple sclerosissrimantp
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
Neuroradiology in multiple sclerosis
MRI in diagnosis of MS
MRI in D.D. of MS
MRI in monitoring disease progression and response to DMT
New imaging techniques
This document summarizes multiple sclerosis (MS), a chronic inflammatory demyelinating disease of the central nervous system. It discusses the etiology, pathology, clinical presentation, imaging features, diagnostic criteria, variants, and differential diagnosis of MS. Key points include: MS is characterized by inflammatory demyelinating lesions ("plaques") in the brain and spinal cord; risk factors include genetic and environmental factors; clinical presentation varies from relapsing-remitting to progressive forms; MRI is important for diagnosis and demonstrates disseminated hyperintense lesions; and differential diagnosis includes ADEM, Susac syndrome, and CNS tumors.
This document discusses remyelinating therapies for multiple sclerosis (MS). It begins by explaining how MS results in demyelination and how remyelination can restore neuronal function. Several potential remyelinating therapies currently in preclinical or clinical trials are described, including clobetasol, opicinumab, guanabenz, and olesoxime. Biomarkers for measuring remyelination like diffusion tensor imaging, magnetization transfer imaging, and positron emission tomography are also summarized. The document concludes that while challenges remain, promising remyelinating strategies exist to provide benefit throughout the entire course of MS.
1) MRI is useful for diagnosing and monitoring multiple sclerosis (MS). Common MRI findings in MS include ovoid lesions perpendicular to ventricles that appear as high signal on T2-weighted and FLAIR images.
2) Different MS subtypes have distinct clinical patterns. Relapsing-remitting MS (RRMS) accounts for 58% of cases and is characterized by neurological symptoms lasting over 24 hours followed by complete or partial recovery with intervals of at least one month between relapses.
3) Optimal MRI protocols for evaluating MS include 3D FLAIR, DIR, and SWI sequences which can help detect cortical and subclinical lesions. Monitoring for contrast enhancing lesions on post-g
This presentation provides an overview of demyelinating diseases, focusing on multiple sclerosis (MS). It defines demyelinating diseases as those that cause myelin destruction while sparing other nervous system elements. MS is described as an autoimmune, inflammatory demyelinating disease of the central nervous system (CNS) that is more common in women. The presentation covers the pathology, clinical features, investigations, and treatment approaches for MS.
A case of Neuromyelitis optica as a presenting manifestation of Systemic Lupu...Apollo Hospitals
Neuromyelitis optica (NMO) is a well characterised, autoimmune, clinicopathological syndrome, which is uncommon and occurs as an isolated entity. Unlike multiple sclerosis, in NMO, the autoimmunity is humorally mediated and the recent availability of Antiaquaporin antibody testing has increased the positive diagnosis of this condition. NMO can also occur in patients with established Systemic Lupus Erythematosis (SLE) who have multiple autoantibodies. The presence of Antiaquaporin antibody is specific for NMO and is seen in patients with SLE who develop inflammatory CNS disease. However, Neuromyelitis optica occurring as a presenting manifestation of SLE is extremely rare and we report one such case.
Multiple sclerosis (MS) is a demyelinating disease in which the insulating covers of nerve cells in the brain and spinal cord are damaged.This damage disrupts the ability of parts of the nervous system to communicate, resulting in a range of signs and symptoms, including physical, mental, and sometimes psychiatric problems
Multiple sclerosis is a chronic disease of the central nervous system characterized by demyelination of nerve fibers. It is an autoimmune disorder where the body's immune system attacks the protective myelin sheath surrounding nerve fibers. Symptoms vary depending on the location of demyelination and include weakness, numbness, vision problems, and difficulties with coordination and balance. There are several types of MS including relapsing-remitting, secondary progressive, primary progressive, and clinically isolated syndrome. The exact cause is unknown but genetic and environmental factors such as infections are thought to play a role in its development.
This document provides an overview of multiple sclerosis (MS), including its characteristics, pathogenesis, clinical course, diagnosis using MRI, and current and emerging treatments. Key points:
- MS is a chronic autoimmune disease affecting the central nervous system, characterized by inflammation, demyelination and axonal loss from early stages. It mainly affects young adults aged 20-40, with higher prevalence in women.
- The clinical course involves both acute relapses and progressive disability. A "topographical model" represents the CNS in layers of increasing vulnerability and shows how disability evolves based on lesion location and the brain's residual reserve.
- MRI plays a critical role in diagnosis by demonstrating dissemination of lesions in
Multiple Sclerosis (MS) is a disease of the central nervous system that affects women more than men and is more common in Caucasians. The typical age of onset is between 20-35 years for women and 35-45 years for men. MRI is an important tool in the diagnosis and monitoring of MS, with findings including lesions in the white matter, corpus callosum, and brainstem. Gadolinium enhancement on MRI indicates breakdown of the blood-brain barrier and active inflammation. While MRI lesion number and location provide some prognostic information, disability as measured by scales such as EDSS correlates poorly with MRI findings. MS pathology involves both acute inflammatory lesions and chronic lesions involving demyelination and axonal loss.
Brain tumors are abnormal cell growths that develop in the brain and can be cancerous (malignant) or non-cancerous (benign). They are the second most common childhood cancer and symptoms depend on the tumor's location and size. Management may include surgery, radiation therapy, and chemotherapy to prevent complications from increased pressure on the skull. Nurses monitor patients for signs of increased intracranial pressure like headaches and vomiting and communicate any changes to doctors for timely intervention. The outlook depends on factors like tumor type, size, location, and how early treatment was initiated.
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.
Brain MRI biomarkers for improved follow up of people with Multiple Sclerosis...Wim Van Hecke
MRI is increasingly used for the diagnosis and follow-up of people with Multiple Sclerosis (MS). However, there is a need for objective MRI biomarkers that can be used in clinical practice. This is now possible. By sending MRI data to a icometrix, reliable and objective reports of brain atrophy and lesion load can be obtained.
This document discusses transverse myelitis, including its causes, differential diagnosis compared to multiple sclerosis and neuromyelitis optica, diagnostic testing, medical management, and role of physical therapy. Transverse myelitis is an inflammation of the spinal cord that presents with weakness, sensory changes, and bowel/bladder issues. It is usually caused by viral infections but can also be idiopathic. Differential diagnosis considers multiple sclerosis, neuromyelitis optica, and other potential causes. Medical management focuses on steroids, plasma exchange, and other immunotherapies. Physical therapy aims to improve function and manage symptoms like spasticity.
Neuromyelitis Optica Spectrum Disorders - Dr. K. GeensEric Tack
This document discusses the history, epidemiology, diagnostic criteria, immunopathology, laboratory findings, and treatment of neuromyelitis optica spectrum disorder (NMOSD). It provides details on the distinctive clinical, MRI, and serological features that differentiate NMOSD from multiple sclerosis. It also outlines the diagnostic criteria for NMOSD with and without aquaporin-4 antibodies. For treatment, it recommends aggressive immunotherapy for relapses followed by immunosuppressants such as azathioprine or mycophenolate to reduce relapse rates. Rituximab is noted as a second-line therapy, and certain DMTs used to treat MS are avoided due to risk of exacerbating NMOSD.
Dr. Shubham Garg discusses neuromyelitis optica (NMO), an autoimmune condition where antibodies attack aquaporin-4 in the central nervous system. NMO predominantly affects women and has a median age of onset of 32-41 years. Key clinical features include transverse myelitis, typically longitudinally extensive, and severe optic neuritis. Treatment involves high-dose steroids for acute attacks and immunosuppressants like azathioprine to reduce relapse rates. Prognosis is generally worse than multiple sclerosis due to risk of cumulative disability, though relapse rates can be lowered with appropriate treatment.
A 25-year-old female presented with poor vision, eye pain, and transverse myelitis. She was diagnosed with Devic's disease, also known as neuromyelitis optica. This is a rare autoimmune disorder where the immune system attacks the optic nerve and spinal cord, causing demyelination. It commonly affects middle-aged women and can cause relapsing episodes of optic neuritis and transverse myelitis. Treatment focuses on managing relapses and preventing future attacks to limit neurological damage and disability.
This document provides an overview of the management of multiple sclerosis (MS). It describes MS as a chronic inflammatory demyelinating disease of the central nervous system that predominantly affects women aged 20-40. The main phenotypes discussed are relapsing-remitting MS, clinically isolated syndrome, secondary progressive MS, and primary progressive MS. Diagnosis involves dissemination of lesions in time and space based on clinical symptoms and MRI findings. Treatment aims to reduce relapse rates and disability progression through disease-modifying therapies like interferons, glatiramer acetate, fingolimod, natalizumab, and dimethyl fumarate. Symptomatic treatments are also discussed.
This document discusses arachnoiditis, an inflammatory disease of the arachnoid membrane surrounding the spinal cord. It develops in three stages: initial nerve inflammation, scar tissue formation causing nerve adhesion, and complete nerve root encapsulation. Causes include trauma from surgery, chemical exposure, and infection. Symptoms include pain, paresthesia, sensory loss, and muscle weakness. Diagnosis involves MRI or CT myelography. Treatment includes corticosteroids, NSAIDs, rhizotomy for pain, and decompression surgery to remove cysts. Physical therapy techniques like exercises, heat, TENS, and neural mobilization can help manage symptoms.
Multiple sclerosis is a disease that damages the myelin sheath surrounding nerve cells in the brain and spinal cord. This damage disrupts communication between nerves and causes a variety of physical, mental, and sometimes psychiatric symptoms. While the exact cause is unknown, it is considered an immune-mediated disease involving both genetic and environmental factors. There is no known cure, but treatments aim to relieve symptoms or slow progression, including drug therapies and complementary approaches like acupuncture, herbal medicine, yoga, and relaxation techniques.
Multiple sclerosis: Medical and Nursing ManagementsReynel Dan
Multiple sclerosis (MS) is a chronic, progressive neurological disease involving demyelination of the central nervous system. It is characterized by exacerbations and remissions of symptoms that vary depending on the location of lesions in the brain and spinal cord. Common clinical manifestations include fatigue, weakness, sensory disturbances, and impaired coordination. While the exact cause is unknown, it is thought to involve an autoimmune response. Treatment focuses on managing relapses, reducing disease progression, and alleviating symptoms. Nursing care emphasizes education, rehabilitation, and supportive measures to help patients maintain optimal functioning.
neuromyelitis optica spectrum disorder Dr. Musa AtarzadehMusa Atazadeh
1. The document discusses the diagnosis and diagnostic criteria for Neuromyelitis Optica Spectrum Disorder (NMOSD) according to the 2015 AAN criteria.
2. The diagnosis involves assessing for core clinical characteristics, compatible neuroimaging findings, and testing for AQP4-IgG antibodies.
3. Certain clinical presentations and neuroimaging patterns can raise red flags and suggest alternative diagnoses rather than NMOSD. Repeating AQP4-IgG testing over time or in the CSF may also be considered in some cases.
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.
1) Multiple sclerosis is an immune-mediated disease that causes inflammation and damage to the central nervous system, often resulting in disability. It primarily affects young and middle-aged adults.
2) Recent advances include more effective monoclonal antibody treatments like natalizumab that greatly reduce relapse rates, but also carry risks like progressive multifocal leukoencephalopathy.
3) New diagnostic criteria allow use of cortical lesions on MRI and certain biomarkers like neurofilament light chain levels provide additional insight into disease activity and progression.
A case of Neuromyelitis optica as a presenting manifestation of Systemic Lupu...Apollo Hospitals
Neuromyelitis optica (NMO) is a well characterised, autoimmune, clinicopathological syndrome, which is uncommon and occurs as an isolated entity. Unlike multiple sclerosis, in NMO, the autoimmunity is humorally mediated and the recent availability of Antiaquaporin antibody testing has increased the positive diagnosis of this condition. NMO can also occur in patients with established Systemic Lupus Erythematosis (SLE) who have multiple autoantibodies. The presence of Antiaquaporin antibody is specific for NMO and is seen in patients with SLE who develop inflammatory CNS disease. However, Neuromyelitis optica occurring as a presenting manifestation of SLE is extremely rare and we report one such case.
Multiple sclerosis (MS) is a demyelinating disease in which the insulating covers of nerve cells in the brain and spinal cord are damaged.This damage disrupts the ability of parts of the nervous system to communicate, resulting in a range of signs and symptoms, including physical, mental, and sometimes psychiatric problems
Multiple sclerosis is a chronic disease of the central nervous system characterized by demyelination of nerve fibers. It is an autoimmune disorder where the body's immune system attacks the protective myelin sheath surrounding nerve fibers. Symptoms vary depending on the location of demyelination and include weakness, numbness, vision problems, and difficulties with coordination and balance. There are several types of MS including relapsing-remitting, secondary progressive, primary progressive, and clinically isolated syndrome. The exact cause is unknown but genetic and environmental factors such as infections are thought to play a role in its development.
This document provides an overview of multiple sclerosis (MS), including its characteristics, pathogenesis, clinical course, diagnosis using MRI, and current and emerging treatments. Key points:
- MS is a chronic autoimmune disease affecting the central nervous system, characterized by inflammation, demyelination and axonal loss from early stages. It mainly affects young adults aged 20-40, with higher prevalence in women.
- The clinical course involves both acute relapses and progressive disability. A "topographical model" represents the CNS in layers of increasing vulnerability and shows how disability evolves based on lesion location and the brain's residual reserve.
- MRI plays a critical role in diagnosis by demonstrating dissemination of lesions in
Multiple Sclerosis (MS) is a disease of the central nervous system that affects women more than men and is more common in Caucasians. The typical age of onset is between 20-35 years for women and 35-45 years for men. MRI is an important tool in the diagnosis and monitoring of MS, with findings including lesions in the white matter, corpus callosum, and brainstem. Gadolinium enhancement on MRI indicates breakdown of the blood-brain barrier and active inflammation. While MRI lesion number and location provide some prognostic information, disability as measured by scales such as EDSS correlates poorly with MRI findings. MS pathology involves both acute inflammatory lesions and chronic lesions involving demyelination and axonal loss.
Brain tumors are abnormal cell growths that develop in the brain and can be cancerous (malignant) or non-cancerous (benign). They are the second most common childhood cancer and symptoms depend on the tumor's location and size. Management may include surgery, radiation therapy, and chemotherapy to prevent complications from increased pressure on the skull. Nurses monitor patients for signs of increased intracranial pressure like headaches and vomiting and communicate any changes to doctors for timely intervention. The outlook depends on factors like tumor type, size, location, and how early treatment was initiated.
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.
Brain MRI biomarkers for improved follow up of people with Multiple Sclerosis...Wim Van Hecke
MRI is increasingly used for the diagnosis and follow-up of people with Multiple Sclerosis (MS). However, there is a need for objective MRI biomarkers that can be used in clinical practice. This is now possible. By sending MRI data to a icometrix, reliable and objective reports of brain atrophy and lesion load can be obtained.
This document discusses transverse myelitis, including its causes, differential diagnosis compared to multiple sclerosis and neuromyelitis optica, diagnostic testing, medical management, and role of physical therapy. Transverse myelitis is an inflammation of the spinal cord that presents with weakness, sensory changes, and bowel/bladder issues. It is usually caused by viral infections but can also be idiopathic. Differential diagnosis considers multiple sclerosis, neuromyelitis optica, and other potential causes. Medical management focuses on steroids, plasma exchange, and other immunotherapies. Physical therapy aims to improve function and manage symptoms like spasticity.
Neuromyelitis Optica Spectrum Disorders - Dr. K. GeensEric Tack
This document discusses the history, epidemiology, diagnostic criteria, immunopathology, laboratory findings, and treatment of neuromyelitis optica spectrum disorder (NMOSD). It provides details on the distinctive clinical, MRI, and serological features that differentiate NMOSD from multiple sclerosis. It also outlines the diagnostic criteria for NMOSD with and without aquaporin-4 antibodies. For treatment, it recommends aggressive immunotherapy for relapses followed by immunosuppressants such as azathioprine or mycophenolate to reduce relapse rates. Rituximab is noted as a second-line therapy, and certain DMTs used to treat MS are avoided due to risk of exacerbating NMOSD.
Dr. Shubham Garg discusses neuromyelitis optica (NMO), an autoimmune condition where antibodies attack aquaporin-4 in the central nervous system. NMO predominantly affects women and has a median age of onset of 32-41 years. Key clinical features include transverse myelitis, typically longitudinally extensive, and severe optic neuritis. Treatment involves high-dose steroids for acute attacks and immunosuppressants like azathioprine to reduce relapse rates. Prognosis is generally worse than multiple sclerosis due to risk of cumulative disability, though relapse rates can be lowered with appropriate treatment.
A 25-year-old female presented with poor vision, eye pain, and transverse myelitis. She was diagnosed with Devic's disease, also known as neuromyelitis optica. This is a rare autoimmune disorder where the immune system attacks the optic nerve and spinal cord, causing demyelination. It commonly affects middle-aged women and can cause relapsing episodes of optic neuritis and transverse myelitis. Treatment focuses on managing relapses and preventing future attacks to limit neurological damage and disability.
This document provides an overview of the management of multiple sclerosis (MS). It describes MS as a chronic inflammatory demyelinating disease of the central nervous system that predominantly affects women aged 20-40. The main phenotypes discussed are relapsing-remitting MS, clinically isolated syndrome, secondary progressive MS, and primary progressive MS. Diagnosis involves dissemination of lesions in time and space based on clinical symptoms and MRI findings. Treatment aims to reduce relapse rates and disability progression through disease-modifying therapies like interferons, glatiramer acetate, fingolimod, natalizumab, and dimethyl fumarate. Symptomatic treatments are also discussed.
This document discusses arachnoiditis, an inflammatory disease of the arachnoid membrane surrounding the spinal cord. It develops in three stages: initial nerve inflammation, scar tissue formation causing nerve adhesion, and complete nerve root encapsulation. Causes include trauma from surgery, chemical exposure, and infection. Symptoms include pain, paresthesia, sensory loss, and muscle weakness. Diagnosis involves MRI or CT myelography. Treatment includes corticosteroids, NSAIDs, rhizotomy for pain, and decompression surgery to remove cysts. Physical therapy techniques like exercises, heat, TENS, and neural mobilization can help manage symptoms.
Multiple sclerosis is a disease that damages the myelin sheath surrounding nerve cells in the brain and spinal cord. This damage disrupts communication between nerves and causes a variety of physical, mental, and sometimes psychiatric symptoms. While the exact cause is unknown, it is considered an immune-mediated disease involving both genetic and environmental factors. There is no known cure, but treatments aim to relieve symptoms or slow progression, including drug therapies and complementary approaches like acupuncture, herbal medicine, yoga, and relaxation techniques.
Multiple sclerosis: Medical and Nursing ManagementsReynel Dan
Multiple sclerosis (MS) is a chronic, progressive neurological disease involving demyelination of the central nervous system. It is characterized by exacerbations and remissions of symptoms that vary depending on the location of lesions in the brain and spinal cord. Common clinical manifestations include fatigue, weakness, sensory disturbances, and impaired coordination. While the exact cause is unknown, it is thought to involve an autoimmune response. Treatment focuses on managing relapses, reducing disease progression, and alleviating symptoms. Nursing care emphasizes education, rehabilitation, and supportive measures to help patients maintain optimal functioning.
neuromyelitis optica spectrum disorder Dr. Musa AtarzadehMusa Atazadeh
1. The document discusses the diagnosis and diagnostic criteria for Neuromyelitis Optica Spectrum Disorder (NMOSD) according to the 2015 AAN criteria.
2. The diagnosis involves assessing for core clinical characteristics, compatible neuroimaging findings, and testing for AQP4-IgG antibodies.
3. Certain clinical presentations and neuroimaging patterns can raise red flags and suggest alternative diagnoses rather than NMOSD. Repeating AQP4-IgG testing over time or in the CSF may also be considered in some cases.
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.
1) Multiple sclerosis is an immune-mediated disease that causes inflammation and damage to the central nervous system, often resulting in disability. It primarily affects young and middle-aged adults.
2) Recent advances include more effective monoclonal antibody treatments like natalizumab that greatly reduce relapse rates, but also carry risks like progressive multifocal leukoencephalopathy.
3) New diagnostic criteria allow use of cortical lesions on MRI and certain biomarkers like neurofilament light chain levels provide additional insight into disease activity and progression.
This document discusses rehabilitation principles for multiple sclerosis (MS). It begins by defining MS as a chronic, progressive disease of the central nervous system characterized by demyelination of the brain and spinal cord. It then covers the epidemiology, pathogenesis, subtypes, common symptoms and signs, diagnosis using the McDonald criteria, disease severity as measured by EDSS, disease-modifying therapies, and approaches to managing common issues like gait impairment and fatigue through rehabilitation and exercise.
- Acute disseminated encephalomyelitis (ADEM) is a monophasic, postinfectious or postvaccine acute inflammatory demyelinating disorder of the central nervous system.
- The first-line treatment for ADEM is high-dose intravenous methylprednisolone for 3-5 days. If corticosteroids fail, plasma exchange or intravenous immunoglobulin can be used as second-line treatments.
- ADEM usually follows a monophasic course, but can occasionally be multiphasic or recurrent. Relapses are usually treated similarly to the initial presentation.
Pediatric multiple sclerosis (MS) is a chronic inflammatory disease of the central nervous system that can affect children and adolescents under 18 years of age. While symptoms are similar to adult MS and include sensory deficits, optic neuritis, motor deficits and fatigue, diagnosis can be more challenging in children due to atypical presentations. The incidence is highest between 13-16 years of age and females are more commonly affected than males. Diagnosis involves evaluating clinical symptoms, MRI images showing lesions, and CSF analysis. Treatment involves disease-modifying drugs like interferons or corticosteroids for relapses.
Multiple sclerosis is a chronic disease of the central nervous system characterized by multiple areas of inflammation and demyelination in the brain, spinal cord, and optic nerves. It commonly begins in young adults and is the most common chronic neurological condition affecting young people. Lesions appear separated in space and time throughout the central nervous system. Common symptoms include visual disturbances, limb weakness, and sensory changes. The cause is thought to involve an environmental trigger in a genetically susceptible individual, leading to an immune-mediated process. While there is no cure, treatment focuses on managing relapses, modifying the disease course, and controlling symptoms.
This document discusses various demyelinating diseases of the central nervous system that can present with myelopathy, including multiple sclerosis (MS), neuromyelitis optica (NMO), acute disseminated encephalomyelitis (ADEM), transverse myelitis (TM), and others. It provides details on the typical MRI findings and locations of lesions for each disease. Key differences between MS and NMO are described, such as the typical involvement of the brainstem and basal ganglia in ADEM compared to MS. The document also outlines distinguishing imaging features between these conditions and other mimics like small vessel disease, tumors, and arterial infarction.
Multiple sclerosis (MS) is a demyelinating disease of the central nervous system that results in inflammation and damage to myelin. It affects more than 2 million people worldwide. Common symptoms include visual impairment, sensory issues, motor difficulties, and fatigue. While the exact cause is unknown, genetic and environmental factors are believed to play a role. There is no cure for MS, but treatments can help reduce relapses and manage symptoms. Exercise and rehabilitation are also important for improving physical function and quality of life for those living with MS.
This document provides an overview of various demyelinating diseases of the central nervous system. It begins by defining demyelinating diseases as those involving disruption of myelin, which forms an insulating sheath around axons. It then classifies and describes several specific diseases, including acute disseminated encephalomyelitis (ADEM), inflammatory demyelinating pseudotumor, multiple sclerosis (MS), neuromyelitis optica, central pontine myelinolysis, HIV encephalopathy, progressive multifocal leukoencephalopathy (PML), and others. For each disease, it discusses clinical features, magnetic resonance imaging (MRI) findings, differential diagnoses, and pathology where relevant.
This document discusses various pathologies that can cause damage to the spinal cord as seen on MRI. It focuses on diseases that appear as high signal on T2-weighted imaging. The most common etiologies are degenerative compressive myelopathy, inflammatory disorders, and demyelinating diseases such as multiple sclerosis. Imaging is important for determining the location, extent, and severity of abnormalities in order to accurately diagnose the underlying cause and guide treatment.
Multiple sclerosis (MS) is a demyelinating disease of the central nervous system where the body's immune system attacks the protective myelin sheath surrounding the nerves. It most commonly affects people between 20-40 years of age. While the exact cause is unknown, genetic and environmental factors are thought to play a role. The four main types are relapsing-remitting MS, primary-progressive MS, progressive-relapsing MS, and secondary-progressive MS. Symptoms vary depending on the affected areas of the brain and spinal cord but may include vision issues, weakness, numbness, and problems with coordination and balance. Diagnosis involves neurological exams, MRI scans and analysis of cerebrospinal fluid
Multiple sclerosis (MS) is a chronic inflammatory disease of the central nervous system characterized by breakdown of the myelin sheath covering nerve axons. It affects over 400,000 people in the US and more than 2.1 million worldwide. Genetic factors, autoimmunity, infection, vitamin D levels, and loss of protective childhood infections may play a role in MS etiology. Clinically, MS presents with a variety of neurological symptoms depending on the location of lesions in the brain and spinal cord, including visual, motor, sensory and cognitive impairments. Disease courses include relapsing-remitting MS, secondary progressive MS, primary progressive MS and progressive-relapsing MS.
This review article discusses the use of magnetic resonance imaging (MRI) in diagnosing and monitoring multiple sclerosis (MS). MRI plays a key role in MS diagnosis by detecting lesions in the brain and spinal cord to demonstrate dissemination of the disease in space and time. Conventional MRI markers described include hyperintense lesions on T2-weighted, proton density, and fluid-attenuated inversion recovery sequences, which indicate demyelination and inflammation. Hypointense lesions on T1-weighted sequences ("black holes") correlate with axonal loss. Lesion number, location and volume provide information on prognosis and can predict disability and disease progression. Non-conventional MRI techniques discussed provide additional insights into MS pathology.
This document discusses demyelinating diseases of the nervous system, specifically focusing on multiple sclerosis (MS). It provides details on the structure and function of myelin sheaths, describes different types of demyelinating diseases including genetic myelinopathies and autoimmune myelinoclasthies like MS. It discusses the epidemiology, pathogenesis, clinical forms and manifestations of MS, including characteristic signs like retrobulbar neuritis, internuclear ophthalmoplegia, and Lhermitte's sign. MRI images of MS lesions in the brain and spinal cord are also included.
This document discusses white matter disorders and imaging findings in multiple sclerosis (MS). It begins by describing white matter composition and how diseased myelin appears on MRI. It then covers the spectrum of white matter disorders, including demyelinating diseases like MS and dysmyelinating diseases. MS is discussed in depth, including its classification as an autoimmune demyelinating disease, prevalence, clinical presentation, and characteristic MRI findings like lesions in periventricular white matter, corpus callosum, brainstem, and spinal cord. Variants of MS like tumefactive demyelinating lesions, Marburg variant, and Balo concentric sclerosis are also summarized.
Multiple sclerosis is a disease where the immune system attacks the myelin sheath surrounding nerves. This damages communication between the brain and body and can eventually damage nerves themselves. Symptoms vary depending on location of damage and affected nerves, and include numbness, vision problems, tingling, fatigue, and more. Most people experience relapses followed by remissions. Eventually, about 60-70% develop steady progression of symptoms. The cause is unknown but is believed to be autoimmune, and risk factors include age, sex, family history, and certain infections. Diagnosis involves ruling out other conditions and may include MRI, spinal tap, and blood tests showing abnormalities associated with MS. Treatment focuses on reducing inflammation with steroids or plasma
The document provides an overview of multiple sclerosis (MS), including its history, types, signs and symptoms, diagnosis, and treatments. MS is an inflammatory disease that damages myelin in the central nervous system. It most commonly affects people aged 20-40 and is more prevalent in women. There are four main types of MS based on symptoms and progression. Diagnosis involves neurological exams, MRI scans, and spinal fluid tests. While there is no cure, current treatments aim to reduce relapses and slow progression by managing symptoms and suppressing the immune system.
Multiple Sclerosis (MS) is a disease of the central nervous system that affects over 400,000 people in the United States. MS occurs when the immune system attacks the protective myelin sheath surrounding the nerve fibers. This damages communication between the brain and body. Symptoms vary depending on location of lesions in the brain, spinal cord, or optic nerves and can include vision issues, mobility problems, numbness, and more. While there is no cure for MS, treatments aim to manage symptoms, speed recovery from attacks, and slow disease progression.
This document provides an overview of common spinal cord diseases characterized by high signal within the cord on T2-weighted MRI. It discusses the differential diagnosis and key features of demyelinating diseases like multiple sclerosis and neuromyelitis optica, acute disseminated encephalomyelitis, transverse myelitis, spinal cord tumors, vascular conditions like infarction and vasculitis. Multiple sclerosis is the most common demyelinating disease and can present with short segment focal lesions in the posterior spinal cord with associated periventricular brain lesions. Neuromyelitis optica preferentially involves the optic nerve and spinal cord.
This project was developed for a competitive intelligence company by mining data from the various information sources e.g. Company (News, Investor Section, SEC filings, Annual Reports, Presentations etc), Universities/Medical Schools/Organizations, Medical Affairs Companies, Non- Profit Medical Agency, Government Agencies, Drug Delivery Companies, Contract Manufacturing Organizations, Contract Research Organizations, Consultancies and Financial Institutions. The complete information available there complied into a single MS word document, listed in MS Excel and then by using MS publisher it was converted into the report which finally converted into PDF.
Dr. Himadri Sikhor is certified as a corresponding member in good standing of the European Society of Radiology for the year 2016. The certificate confirms Dr. Sikhor's membership status and is signed by Prof. Katrine Riklund, Chairperson of the ESR Board of Directors.
This certificate recognizes Dr. Himadri Sikhor Das for his professional expertise as an international judge at the 2nd International Scientific E-Conference held from November 16-26, 2015. The certificate was issued by Texila American University to honor Dr. Das's contributions as a judge during the online conference that had over 800 registrants from 69 countries.
Dr Himadri Sikhor Das pursued radiology after becoming fascinated by the vast knowledge of anatomy and pathophysiology demonstrated by radiology residents while he was a surgery resident. He now owns his own successful radiology practice. Some of the benefits of owning his own practice include freedom and flexibility to set his own protocols. Some challenges in setting up a radiology lab included securing funding for equipment, finding an appropriate location, and obtaining necessary government clearances and approvals. He deals with challenges by fully understanding the problem and then working to find solutions without shortcuts. His advice for radiology students is to work hard to build a strong foundation in disease anatomy and pathology.
Imaging in neuro ophthalmology & revisting orbital imaging.2012 (1) (1)Dr. Himadri Sikhor Das
This document provides an overview of imaging in neuro-ophthalmology and orbital anatomy. It discusses the anatomy and imaging appearance of the visual pathway, optic nerve, extraocular muscles, vessels and nerves in the orbit. Common pathologies are described including papilledema, optic neuritis, tumors of the optic nerve, sellar region, and orbit. Imaging modalities useful for evaluation including CT, MRI, MR angiography and ultrasound are also mentioned. In summary, it serves as a comprehensive review of normal orbital anatomy and variations as well as pathologies of the visual system that can be evaluated with medical imaging.
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-
This document provides a differential diagnosis for various neurological and head/neck conditions organized by location and imaging findings. Some of the most common causes included are:
1. Intracranial hemorrhage is most often due to hypertension, tumors, trauma, or aneurysms.
2. Aneurysms are commonly saccular and degenerative or traumatic in nature.
3. Spinal cord compression is often caused by compression fractures, disk disease, or primary bone disorders like Paget's disease.
4. Intracanalicular internal auditory canal masses are typically acoustic neuromas or facial neuromas.
This document discusses various abnormalities, fractures, and pathologies that can occur in the cervical vertebrae and craniocervical junction. It describes os odontoideum, persistent ossiculum terminale, Jefferson fractures, three types of odontoid fractures, hangman's fractures, Chiari malformations, rheumatoid arthritis, tuberculosis, and various tumors that can affect this region. Imaging findings for many of these conditions are also presented.
This document discusses imaging of the cranio-vertebral junction. It begins by defining the cranio-vertebral junction and its key anatomical parts. It then discusses various imaging modalities for evaluating the CV junction, including plain radiographs, CT, MRI, and angiography. Specific abnormalities that can be seen include basilar invagination, atlantoaxial subluxation, occipital anomalies, and os odontoideum. Measurement lines and angles used in evaluation are also defined.
Hepatocellular carcinoma (HCC) is the most common type of liver cancer. Risk factors include cirrhosis of the liver, hepatitis B and C infections, and exposure to certain chemicals. HCC can be solitary or multifocal tumors that vary in appearance and may invade blood vessels. Diagnostic imaging tools like ultrasound, CT scans, and MRI are used to identify and characterize HCC lesions based on features like vascularity, enhancement patterns over time with contrast agents, and signal intensities on T1- and T2-weighted MRI sequences. These tools help determine if the tumors are confined to the liver or have spread.
A 41-year-old man presented with increasing weakness in all four limbs and neck pain. MRI revealed spondylodiskitis and a tubercular spinal cord lesion at the C6-C7 level. The lesions showed characteristic signal patterns and rim enhancement. Treatment with anti-tubercular drugs led to improvement of symptoms and regression of lesions on follow-up MRI. This case demonstrates the rare occurrence of simultaneous tubercular spondylodiskitis and spinal cord tuberculoma at the same vertebral level.
MRI is the most useful imaging modality for evaluating the spine. It can be used to diagnose degenerative spinal diseases, spinal infections, bone marrow diseases, congenital anomalies, and craniovertebral junction abnormalities. MRI provides high quality images of soft tissues and bones without radiation, allowing early detection and diagnosis of various spinal pathologies important for orthopedic surgeons. It is particularly useful for diagnosing degenerative disc disease, spinal infections like tuberculosis and pyogenic spondylitis, and bone marrow disorders.
Functional magnetic resonance imaging (fMRI) techniques like BOLD-fMRI can noninvasively image the brain with high spatial and temporal resolution. BOLD-fMRI measures oxygenated blood flow changes to map brain activity. It has several applications including studying language, vision, movement, and memory. Other fMRI methods include perfusion fMRI, diffusion-weighted fMRI, and MRI spectroscopy, which can provide additional functional or metabolic information about the brain. These techniques hold promise for advancing understanding of psychiatric and neurological disorders.
This document discusses the MR morphology of intracranial tuberculomas based on a study of 10 patients. Key findings include:
1) Tuberculomas showed variable signals on T1 and T2 weighted MR images depending on their stage of evolution and composition.
2) Most lesions appeared hypointense on T2 weighted images due to fibrosis, scar tissue, and free radicals from macrophages.
3) MR was useful for visualizing the full extent of lesions, differentiating tuberculomas from other pathologies, and delineating internal components like necrotic centers.
4) Follow up MR in patients responding to treatment showed reduction in lesion size and surrounding edema.
The document summarizes the anatomy of the cerebral venous system and dural sinuses. It describes the superficial and deep venous systems that drain blood from the brain. The superficial system includes cortical veins and sagittal sinuses, while the deep system includes lateral, straight, and sigmoid sinuses that drain deeper cortical veins. These systems drain into the internal jugular veins. The document highlights key anatomical features of the veins and sinuses and their clinical relevance to understanding cerebral venous thrombosis.
This document provides an overview of the brachial plexus including its anatomy, clinical presentations, and imaging indications and findings for various pathologies. The brachial plexus originates from the cervical spinal nerve roots C5-T1 and provides motor and sensory innervation to the upper extremity. Common pathologies include traumatic injuries, neoplasms, inflammation from radiation therapy, and infections. Magnetic resonance imaging is often the preferred imaging modality to evaluate the brachial plexus due to its ability to characterize soft tissues and visualize the nerve roots.
This study evaluated 7 children clinically diagnosed with Neurofibromatosis type 1 (NF-1) using MRI to look for characteristic brain lesions. 4 patients showed focal areas of increased signal on T2-weighted MRI in typical locations including the globus pallidus, midbrain, and cerebellar peduncles. These lesions were believed to represent non-neoplastic hamartomatous changes and lacked mass effect or enhancement. The study concluded these lesions are common in around 50% of children with NF-1 and represent benign vacuolar changes in myelin that increase in size and intensity from ages 8-10 years before fading in adolescence.
The document discusses imaging for various types of trauma, focusing on craniocerebral trauma, spinal trauma, chest trauma, and pelvic trauma. For head injuries, CT is recommended as the initial investigation to evaluate brain injuries. Plain films are used to evaluate spinal and bone injuries. CT is also recommended for suspected spinal injuries, as it allows viewing the entire cervical spine in axial, sagittal, and coronal reconstructed images. Any neurological deficit indicates major trauma requiring CT and possibly MRI.
1) A 41-year-old man presented with increasing weakness in his limbs, mild fever, and neck pain.
2) An MRI revealed spondylodiskitis (infection and inflammation of the vertebral disk and vertebrae) between his C6 and C7 vertebrae, as well as a focal lesion within the spinal cord at the same cervical level.
3) The disk and cord lesions showed characteristic signals and enhancement on MRI that were diagnostic for tuberculous infection. Treatment with anti-tuberculosis drugs resulted in improvement of symptoms and regression of the lesions on follow-up MRI.
Imaging plays a crucial role in diagnosing and distinguishing between benign and malignant hepatic masses. Multiphase CT and MRI are useful for evaluating lesions, the surrounding liver, and determining the extent of involvement. Small lesions less than 1.5 cm are often difficult to characterize and may require biopsy for diagnosis.
1. MULTIPLE SCLEROSIS: Overview and role of MR imaging
Himadri Sikhor Das,MD
Multiple sclerosis (MS) is an idiopathic inflammatory and most common demyelinating
disease of the CNS. Most people with this disease are affected in their prime of their lives,
usually between 20 and 40 years of age though exceptions have been documented. Cause of
this disease remains unknown. Genetic, viral, autoimmune and environmental factors have
been implicated in the disease.
Pathologic hallmark of MS is multicentric and multiphasic CNS inflammation and remyelination
scattered over space and time. In MS, cells of the immune system invade the CNS and
destroys the myelin cover leading to demyelination of the axon and damage to the axon itself.
In response, other cells of the CNS produce a hard sclerotic lesion (“ the MS plaque”)
around the multiple demyelinated sites. Areas of axonal damage can be measured by
magnetic resonance spectroscopy (MRS) and is found to correlate with clinical disability. Few
lesions in non-eloquent areas do not produce clinical symptoms or neurological dysfunction.
Such lesions are referred to as “silent lesions”. Approximately 1 per 1000,000 people acquire
MS internationally. Throughout adulthood, the female to male ratio is 2:1.
Clinical features:
Sensory problems occur in 20%-50% of patients and are often the earliest symptoms. These
manifest as tingling, tight band feeling, crawling sensations etc are found in the extremities and
in the trunk and are referred to as paresthesias. Few patients may experience an electric like
sensation that goes down the back and legs with head or neck motion (Lhermitte’s sign).
Optic neuritis is the presenting symptom in 15%-20% of patients with MS and usually starts
with blurring of vision followed by loss of vision. May appear on one side followed by a later
appearance in the other. It rarely involves both eyes simultaneously.
Spasticity occurs due to cortico-spinal tract involvement . Occurs with the initial attack of MS
in 30%-40% of patients. It is present in 60% of patients with progressive disease. Usually legs
are involved more than the arms.
Other clinical features of MS includes gait and balance incoordination, bladder & bowel
dysfunction, fatigue (the single most complaint of people with MS), heat sensitivity, cognitive
and emotional dysfunctions etc.
Diagnosis of MS is based on a classic presentation (optic neuritis, transverse myelitis,
paresthesias etc) and on the identification of other neurological abnormalities, which is
indicated by the patients history and clinical examination. Typical findings in MRI greatly help
to establish diagnosis of MS. Patients with atypical presentations and /or a normal or atypical
MRI may require evoked potential studies to know about subclinical neurological abnormality.
CSF analysis is done to exclude treatable conditions and to document immunological activity in
the CNS. Oligoclonal bands are present in over 90% of definite MS, though these can be seen
in other inflammatory diseases and in 7% of
normal controls. An IgG index of >0.7 is seen in 86%-94% of MS patients and is usually the
first CSF abnormality in early MS. 25% patients show elevated protein levels. Presence of
myelin basic protein in CSF indicates demyelination though these also can be seen in other
neurological conditions like infections, infarct etc. However this protein can be found in the first
2 weeks after a substantial exacerbation in 50%-90% of patients.
2. Course of disease: The natural course of MS is highly variable and it is impossible to predict
the nature, severity or timing of progression in a given patient. Patients with sensory problems
tends to have a better prognosis than those with spasticity or paralysis. Another factor that
influences prognosis is age of onset. Disease progression tends to be more rapid in patients
who experience their first symptoms after age 40. Other factors predictive of rapid progression
include male gender, frequent attacks and burden of disease as detected by MRI scans.
Classifications of MS :
Clinically definite MS is further categorized according to disease course. Relapsing-remitting
MS (RR-MS) is characterized by symptoms that develop over a period of a few hours to a few
days, followed by recovery and a stable course between relapses. Approximately 80% of
patients are initially dignosed with relapsing-remitting MS. Almost 50% of patients with
relapsing- remitting MS eventually develop secondary-progressive MS (SP-MS)
characterized by gradual neurological deterioration with or without superimposed acute
relapses. If there is continual disease progression from onset with only minor fluctuation the
classification becomes primary-progressive MS (PP-MS). PP-MS occurs in approximately 10
% of patients and mostly who are > 40 years of age. Progressive-relapsing MS (PR-MS), a
rare from of the disease, is characterized by gradual neurological deterioration from the onset
of symptoms to subsequent relapses.
MR IMAGING IN MS:
MR imaging is the modality of choice in patients with MS. Use of MRI in MS was first
described by Young et al in 1981. Previously spin echo (SE) sequences like T1, T2 and PD
weighted images are commonly used to screen patients with MS. Recently fast or turbo spin
echo (FSE & TSE) techniques with similar PD and T2 weighted lesion contrast has become
popular because this sequences utilize ¼ to 1/3rd
of acquisition time. Very small lesions can be
missed on FSE sequences because of edge blurring, but taking thinner slices compensates it.
Recent MR developments in imaging of white matter disease :
Nowadays FLAIR (fluid attenuated inversion recovery) sequences are widely used because
heavily T2 weighted images can be obtained with CSF suppression and enables greater lesion
conspicuity in the gray white interface areas. Another technique is EPI (echo planar imaging).
Use of EPI FLAIR is very useful in detecting early lesions that do not enhance such as
Demyelinating disease, acute infarcts and infection.
Diffusion weighted imaging (DWI) :
Normal white matter exhibit anisotropic diffusion with increased diffusion parallel to white
matter fibers and restricted diffusion present perpendicular to these fibers. Demylination results
in increase in extracellular space which in turn results in increase in water diffusion and
diffusion coefficient as compared to normal white matter. Hence in MS, both in acute and
chronic plaques there will be increase in diffusion coefficient. Acute plaques has higher
diffusion coefficient than chronic plaques probably due to gliosis in chronic plaques. Currently
3. modalities like DTI (diffusion tensor imaging) and FA (fractional anisotropy) are being utilized
for more research in MS.
Quantative magnetisation transfer (MT) technique :
Useful in MS patients on drug therapies to know the disease activity. In active plaques there is
little demyelination and their MT ratio is slightly reduced which indicates that lesions are most
likely to respond to methylprednisolone and more likely to disappear. In contrast chronic
plaques have more demyelination and very low MT ratio. These are unlikely to respond to any
drug therapy. This technique is now applied to other white matter disease also.
Magnetic resonance spectroscopy (MRS):
This technique does not produce images but graphs that display levels of metabolites as zones
of different colors or shades of gray known as spectroscopic images. In MS tissue metabolite
like NAA ( N - acetyl aspartate ) is decreased in chronic plaques and remains normal in active
plaques.
MR appearance of MS lesions:
Lesions are typically nodular or ovoid in appearance. Size varies from few mm to more than
1cm. Lesions have propensity to involve the large white matter tracts particularly corpus
callosum, medial longitudinal fasciculus and middle cerebellar peduncle. Lesions can also be
found in juxtacortical location involving the “U” fibres, along the perimedullary veins at the
calloso-septal interface and also in periventricular location giving rise to the classical
“Dawson’s fingers appearance”. MS lesions however can involve any portion of the white
matter. Recently presence of “ Subcallosal Striations”has been described using sagittal
FLAIR sequence. These are thin white lines radiating from the calloso-septal interface and
represents the earliest manifestation of MS in this location. Occasionally, MS lesions present
as large lesions with mass effect and vasogenic edema indistinguishable from brain tumor by
MR imaging (tumefactive MS plaque). Other nonspecific findings include thinning of the
corpus callosum, dirty white matter on T2 weighted images and deposition of non haem iron in
the basal ganglia with progression of the disease
Spinal MS : Spinal MS has a predilection for the cervical spinal cord ( 67 % of cases), with
preferential eccentric involvement of the dorsal and lateral areas of the spinal cord abutting the
subarachnoid space around the cord. About 55 to 75 % of patients with MS have spinal lesions
at some point of time during the course of the disease. As many as 20% of spinal MS lesions
are isolated. Spinal lesions enhance after contrast administration. Enhancement may last for 2
to 8 weeks. Steroids do not suppress enhancement of active plaques. Chronic plaques do not
enhance and often demonstrate focal cord atrophy. Lesions of other etiologies ( eg, viral
myelitis, ADEM ) may resemble MS plaques and must be considered along with the clinical
history and the patients sign and symptoms.
Typical MR morphology of MS lesion:
Initially MS lesions are isointense to mildly hypointense (black) on T1 weighted images. With
time, the hypointensity progresses to develop the so-called “T1 black hole”. Some lesions
show slight peripheral hyperintensity surrounding the lesion due to presence of free radicles in
the surrounding inflammatory tissues. On T2 and PD weighted images the lesions are usually
hyperintense (bright).
4. Role of contrast administration in MS :
In MS contrast enhanced MRI plays an important role depending on the clinical context.
Contrast enhancement in general indicates the presence of active inflammatory process. Non
enhancing lesions are thought to be chronic lesions. Presence of enhancing and non-
enhancing lesions is strong evidence to indicate that these multiple lesions are separated in
time supporting diagnosis of MS. Presence of ring enhancement suggest reactivation of an old
lesion, the central nonenhancing portion representing the “burnt out” portion of the lesion. An
incomplete or open ring enhancement is more indicative of an MS lesion.
MR imaging criteria for clinical progression to MS in patients with clinically isolated
syndromes (CIS). MS typically presents as an acute reversible episode of neurologic
dysfunction.
Paty et al ( 1988 ) : 4 lesions ( Paty A)
: 3 or more lesions, including 1 periventricular lesion (Paty B)
Sensitivity 86 %, Specificity 54 %
Fazekas et al (1988): 3 lesions with 2 of the following properties.
: 5 or > 5 mm diameter of lesion.
: Infratentorial or periventricular location.
: Sensitivity 86 %, Specificity 54 %
Barkhof et al ( 19 97 ) : 4 lesions criteria
: 1 or > 1 Juxtacortical lesion.
: 1 or > 1 enhancing lesion or > 9 nonenhancing lesion.
: 1 or > 1 infratentorial lesion.
: 3 or > 3 periventricular lesions. (Sensitivity and specificity 73%)
Proposed new diagnostic category: MR imaging supported definite multiple sclerosis
(MRISDMS)
1. Age – Not older than 45 yrs.
2. At least one MS –like clinical episode with appropriate clinical findings, remission not
necessary.
3. Abnormal MR image findings (strongly suggestive of MS).
a. Four or more white matter lesions ( > 3 mm diameter ).
b. 3 lesions with at least one located in periventricular location.
4. One or more of the following specific features.
a. Involvement of corpus callosum.
b. Infratentorial location.
c. Oval shape.
d. > 6 mm in diameter.
e. Some but not all enhancing.
5. Variants of MS –
Balo’s concentric sclerosis: - Rare, affects young adults, last for few months, concentric
bands of intact myelin and demyelinated zones, responds to steroid.
Devic’s disease: - (neuromyelitis optica) Spinal cord and optic nerves affected.
Brain spared. Brain MRI normal. MRI spine shows striking lesions.
Marburg’s disease: - Acute form of MS. Fulminant and progressive.
Schilder’s disease: - Rare, affect children, visual problems and cortical blindness,
Seizures, headache, vomiting, large bilateral hemispheres demyelination.
Monophasic syndromes: - Optic neuritis, acute transverse myelitis, ADEM, acute
inflammatory brainstem syndrome.