Positive autoradiographic findings in brains of four MS patients

Autoradiography of brain slices from 4 multiple sclerosis (MS) and 9 control patients was performed. After 6 weeks of exposure the exact picture of the white matter appeared on the X-ray films in all cases with MS, but only in one of the controls. The high level of autoradiographic signal from MS white matter suggests that an abnormal accumulation of radioactive trace elements takes place within the brains of MS victims.     

CT and EEG investigations in 100 patients with multiple sclerosis (MS)

100 MS patients were followed up for an average of 5 years. We considered age at onset, duration of the disease, number of attacks, neurological and psychic status, CT and EEG findings and tried correlating the last two with all the previous factors. In remission the most frequent CT abnormality was diffuse atrophy. In acute exacerbations there were 3 possibilities: normality, hypodensity and, much more rarely, hyperdensity with pseudotumoral patterns. A normal CT and short duration of disease were positively correlated with a small number of attacks. There were no positive correlations between CT findings, age at onset and neurological and psychic status. EEG, like CT, may show no changes in a high percentage of cases but there is scant correlation between the two.

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Sommario 100 soggetti affetti da Sclerosi Multipla sono stati seguiti per un periodo medio di 5 anni. Abbiamo indagato l'età di inizio, la durata della malattia, il numero di poussées, il quadro neurologico e psichico, i reperti TC ed EEG. Gli ultimi due parametri sono stati correlati con tutti i precedenti. In fase stabilizzata le alterazioni TC più frequenti sono risultate le atrofie diffuse. In fase acuta sono state riscontrate 3 possibilità: reperto negativo, ipodensità e, molto più raramente, iperdensità con quadri pseudotumorali. Correlazioni positive sono state riscontrate tra normalità TC e durata breve della malattia da un lato e numero scarso di poussées dall'altro. Invece non sono risultate correlazioni positive tra reperti TC, età di inizio della malattia ed obiettività neurologica e psichica. Anche l'EEG, come la TC, è risultata alterata in un'alta percentuale di casi; dalle correlazioni EEG-TC è risultato però che la concordanza di tali alterazioni è stata piuttosto scarsa.

     

Multiple ring enhancement in a case of acute reversible demyelinating disease in childhood suggestive of acute multiple sclerosis

A 5-year-old Japanese boy was admitted to our hospital because of progressive visual disturbance and quadriplegia. Computed tomography (CT) revealed multiple low density areas in the cerebral white matter, and intravenous injection of contrast medium resulted in ring enhancement around these areas. Exploratory aspiration of one of the low density areas gave a xanthochromic, viscous fluid. Pathologic examination of the drained fluid demonstrated small pieces of brain tissue with necrotizing lesions surrounded by demyelinating areas. The patient has been followed up for 3 years with corticosteroid treatment, and marked improvement has been achieved both in neurological examination and CT findings. From these clinicopathological findings an acute form of multiple sclerosis (MS) in childhood was suspected.     

Cytoproteic CSF findings in 33 MS patients: usefulness for diagnosis

Although multiple sclerosis (MS) is mainly defined on clinical grounds, CSF parameters still remain important diagnostic and scoring tools. To demonstrate the usefulness of some easy laboratory techniques, a CSF cytomorphological and agarose gel electrophoresis (AGE) evaluation was undertaken in 33 MS patients: 79% presented a lymphoid cell profile and in 73% the gamma globulin fraction was abnormal. In the great majority of cases (97%) either or both cytological and electrophoretical abnormalities were found.     

Computed tomography in tuberous sclerosis--with special reference to relation between clinical manifestations and CT findings.

Concerning the clinical signs and symptoms, we noticed skin white macula in 87%, adenoma sebaceum in 53%, mental retardation in 75%, retinal phacoma in 54% and seizure in 92%. Numbers of nodules ranged from zero to 11, and showed no correlation with aging. Half of the cases showed slight ventricular dilatation, one quarter showed moderate dilatation and the remainder were normal. There was no definite correspondence between size of the ventricle and number of nodules. There were relatively many cases with normal mental state in the group with normal ventricles. In adult cases a large ventricle does not always mean poor prognosis in mental state. Almost all of the cases with cortical atrophy had mental retardation. In the group with moderate dilatation infantile spasms were the most frequent type of seizure. On the contrary, grand mal was most frequent in the normal group. As for the position of nodules there was no difference between the normal and dilated groups. Nodules were predominantly seen in the lateral aspect of the body, trigone of the lateral ventricle and adjacent to the foramen of Monro. Asymmetrical lateral ventricles were noticed in 18%. Incidence of laterality increased as dilatation proceeded. It was larger on the left side in 9 out of 11 cases. We have no reasonable explanation of this tendency. There was one case with a tumor which was verified by enhanced CT. There were five cases with brain anomalies.     

Diagnostic CT scan findings in an adult case of acute disseminated leuco-encephalitis

Summary A complex neurological syndrome, which rapidly appeared in a 54-year-old woman, created strong diagnostic difficulties. In fact, while the carotid-angiography was negative and CSF not significant, the scintigraphy suggested a multifocal metastatic or infarctual pathology. The CT scan easily allowed us to resolve the diagnostic problem, showing in the oval centres numerous enhanced areas which were consistent with a disseminated leuco-encephalitis. This case confirmed the opinion of the authors that CT scan may usefully contribute to the diagnosis of the demyelinating disorders of CNS.Neuroradiological Service     

多发性硬化的影像学研究进展

多发性硬化（multiple sclerosis,MS）是中枢神经系统的慢性炎性脱髓鞘疾病,是导致青壮年非创伤性残疾的主要疾病之一。临床上常以肢体无力、感觉异常、眼部症状、共济失调、发作性症状及精神症状为主要特征。以往MS的诊断依赖临床表现和病理组织学,随着神经影像学技术的发展,可以帮助我们早期发现无临床症状的MS病变,并作为疾病的亚临床证据。现代神经影像学技术已从结构影像学、功能影像学发展至分子影像学阶段,常用于MS辅助诊断的结构影像学技术包括磁共振成像、弥散张量成像、光学相干断层成像等,这些技术可以显示病灶的具体形态结构、判断病灶的新旧,为临床分期和治疗提供依据。功能影像学技术包括功能磁共振成像及动脉自旋标记等,可以从代谢水平、血流动力学等方面对MS患者的脑功能活动进行评价,从而为MS的诊断、分期、预后评估提供影像学依据。分子影像学技术包括磁共振波谱成像及正电子发射体层扫描等,可以在MS的发病机制、早期诊断、病情评估、疗效评价等方面提供支持。功能影像学及分子影像学技术的发展,弥补了结构影像学技术不能发现无解剖学改变的MS的缺陷,特别是分子影像学技术,通过对MS发生过程中关键标记分子的成像,可以从组织、细胞及分子水平探究疾病发生发展的过程,直观反映疾病的病理生理学变化,通过设计特异性探针,还可以为研究药物新靶点提供思路。 [国际神经病学神经外科学杂志, 2023, 50(3): 91-96]     

Asymptomatic MS

“Asymptomatic multiple sclerosis (MS)” or “subclinical MS” describes “a clinically silent disease state of MS” discovered by chance either by imaging or at autopsy, or with incidental findings shown by other diagnostic tools that are consistent or suggestive of MS, and that cannot be explained by any other disease or condition.Since the early 1960s there have been a number of autopsy studies reporting cases, in which histopathological brain changes consistent with MS were found, despite that none had any clinical symptom or sign of the disease during their lifetime. Several reports have also shown that asymptomatic first-degree relatives of MS patients may have oligoclonal bands in their cerebrospinal fluids or may turn out to have abnormal evoked potential studies.With the extensive availability of MRI lately, the incidence of individuals having these studies performed for indications other than suspicion of inflammatory demyelinating disease of the central nervous system (CNS) such as primary headaches or trauma, revealing unsuspected brain and/or spinal cord lesions compatible with MS had raised. A number of such case-series reported recently had resulted in increased awareness of this finding and to its relationship to clinical multiple sclerosis. This situation is now referred as “radiologically isolated syndrome (RIS)” and is the most common type of “asymptomatic MS”.Since it is well known that MS has an asymptomatic period of unknown duration in many individuals preceding its initial presentation, either as a clinically isolated syndrome or in rare instances as primary progressive-MS, it is likely that a number of MS patients will be diagnosed by chance as RIS at an early stage before converting to clinical disease. Currently this issue has gained a wide interest as there are no established protocols regarding how to study and follow these individuals or whether they should be treated or not! However, not all patients with RIS are predestined to develop clinical disease and it was recently shown that the rate of conversion to clinical MS is about one-third of RIS cases at five years. Although that there may be some risk factors suggestive of a higher or earlier conversion to clinical disease, none are definite and the current evidence is not supportive of initiating treatment in patients diagnosed as RIS.     

Magnesium concentration in plasma and erythrocytes in MS

There are few reports of Mg in MS and none dealing with Mg content in erythrocytes. Mg concentration was determined in serum and in erythrocytes with the help of a BIOTROL Magnesium Calmagite colorimetric method (average sensitivity: 0.194 A per mmol/I) and a Hitachi autoanalyzer in 24 MS patients (7 men and 17 women, age 29–60; 37 years on average with the duration of the disease: 3–19; 11 years on average, at clinical disability stages according to the Kurtzke scale: 1–7; 3.2 on average, in remission stage. A statistically significant decrease (p <0.001) of Mg concentration in erythrocytes and no changes in plasma of MS patients were found. The results obtained suggest the presence of changes in membrane of erythrocytes which could be connected with their shorter life and with affection of their function.     

MS in the Faroe Islands and the possible protective effect of early childhood exposure to the "MS agent"

Epidemiologic data on multiple sclerosis (MS) in the Faroe Islands have been interpreted by the original investigators as supporting a particular infectious disease model. They suggest that MS occurs as a late consequence of extended exposure to an infectious agent which cannot be transmitted to subjects younger than 11 years of age. However, the Faroes data may better fit an alternate model, in which MS results from delayed primary exposure to an infectious agent which more commonly produces benign illness and protection against MS in subjects who are exposed in infancy or early childhood.     

Fatigue in MS is associated with specific clinical features

Introduction – fatigue is a common and disabling symptom in multiple sclerosis (MS). In this study we evaluated if fatigue is associated with different demographic and clinical features of MS. Material - A survey was performed on 507 consecutive patients affected by clinically definite MS referred to our centre between January 1 and December 31, 1993. During the examination patients were asked to answer a brief fatigue questionnaire. To evaluate the probability of the occurrence of fatigue in association with several covariant factors (age, sex, duration, disease form, disease severity, month of examination, functional sub-systems on the expanded disability status scale (EDSS), a logistic regression analysis was performed. Results - we confirmed that fatigue is common in MS, recorded in 53% of patients. Patients affected by a more severe disability, by progressive MS, both primary and secondary, with an older age at examination, and assessed during spring, had a significantly higher risk of fatigue. Sex was not associated with the occurrence of fatigue. When the single items of EDSS were considered, we found that fatigue is also associated with the occurrence of cerebellar, sphincteric, pyramidal and sensitive signs, but not with brain stem, visual and cognitive impairment. Conclusion - fatigue in MS is more frequent in association with specific clinical features.     

Critical fusion frequency in MS during mild induced hyperthermia

By raising the body temperature of 0.5 degrees C the critical fusion frequency of a flickering light increases in normal subjects but decreases in multiple sclerosis (MS) patients. The change was present in 14 patients with definite MS and in 5 of 10 patients with probable MS. No clinical worsening was observed during the procedure or in the following hours.     

Effects of recombinant α-2b-interferon therapy in patients with progressive MS

The effects of systemic recombinant interferon-α-2b were studied in 6 carefully selected patients with progressive multiple sclerosis. 3.0 million IU were given as daily subcutaneous injections for 6 months, 5 patients showed worsening disability, and in 4 of them new or enlarged lesions were detected in MRI. In one patient no change in disability was found; his MRI showed regressed changes. The mean progression index during the treatment was significantly higher (p < 0.02) than during the previous 2 to 3 years' period of continuous progression. The frequency of peripheral blood natural killer (CD16 +) cells declined significantly 3 months during the treatment, but returned to the pretreatment values after termination the treatment. An increase of intrathecal IgG synthesis and oligoclonal bands was demonstrated in 4 and 3 patients, respectively. Our experience suggests that long-term recombinant IFN-α-2b treatment may activate the immunological process of MS.     

Intravenous gamma globulin in progressive MS

In an attempt to prevent disease exacerbations, intravenous gamma globulin (500 mg to 2 g/kg) plus methylprednisolone was administered monthly to 14 patients with progressive multiple sclerosis, 11 of whom were steroid dependent. Seventeen exacerbations of disease activity were seen in 11 patients over a mean follow-up period of 7.8 months. Four exacerbations occurred in 3 patients within one month of receiving 1.6 to 2.0 g/kg of intravenous gamma globulin (IVGG). Most exacerbations occurred within 2 weeks of steroids being tapered; thus a steroid sparing effect of IVGG could not be demonstrated. We conclude that IVGG plus methylprednisolone can be given safely at monthly intervals for a prolonged period but in the dosage administered did not prevent exacerbations in 80% of patients with progressive multiple sclerosis.     

脑结节性硬化的CT特征

目的 分析脑结节性硬化症的CT影像表现，进一步认识其影像特征。方法 对19例脑结节性硬化患者的CT影像表现进行分析。结果 (1)皮层和皮层下病灶：CT显示病灶58个，面包圈样改变病灶23个，局部小片状高密度7个病灶，等密度伴有钙化点病灶28个。(2)脑白质病灶：CT发现6个病灶有钙化点，提示该处有病灶。(3)室管膜下病灶：CT发现钙化结节127个。其中2例合并巨细胞星形细胞瘤，CT表现为高、等、低混杂密度。结论 CT不仅可以显示室管膜下钙化结节．也可以较好地显示出皮层及皮层下结节。     

WT1 and interferon‐β–vitamin D association in MS: a longitudinal study

The above article from Acta Neurologica Scandinavica, published online on 7 April 2005 in Wiley Online Library (wileyonlinelibrary.com) and in Volume 111, pp. 329‐332, has been retracted by agreement between the journal Editor in Chief, Professor Elinor Ben‐Menachem, and John Wiley & Sons Ltd. The article has been retracted because a similar article had previously been published in the Jugoslovenska medicinska biohemija in 2003. The authors presumed that since the journal was no longer existing, they felt the need to re‐publish their work in Acta Neuorologica Scandinavica. However, in the consideration of the Journal, this constitutes dual publication. References Selakovi?VM, Jovanovi?MD, Mihajlovi?R, Radenovi?LLJ. Cytochrome c oxidase in patients with acute ischaemic brain disease. Jugoslovenska medicinska biohemija. 2003;22:329–334. Selakovi?VM, Jovanovi?MD, Mihajlovi?RR, Radenovi?LLJ. Dynamics of cytochrome c oxidase activity in acute ischemic stroke. Acta Neurol Scand. 2005;111:329–332.     

CSF and serum ganglioside antibody patterns in MS

The authors determined CSF and serum IgG and IgM antibodies to seven gangliosides in 48 patients with multiple sclerosis. Differing ganglioside antibody patterns in CSF but not serum allowed to reclassify 93% of MS patients correctly when compared to patients with Guillain-Barré syndrome or neuroborreliosis. This suggest that the antibody patterns are neither random nor alike in inflammatory diseases of the nervous system. CSF ganglioside antibody titres were found to be different for patients with relapsing remitting (RRMS; n = 35) and chronic progressive (CPMS; n = 13) multiple sclerosis. Our study reveals characteristic ganglioside antibody patterns in MS and confirms previous evidence of disturbed immunoregulation in MS.