C. Besada

Brain atrophy in radiologically isolated syndromes.

The aim of this study was to compare brain atrophy in radiologically isolated syndrome (RIS), in clinically isolated syndrome (CIS), and in individuals with subjective complaints (ISC).

Brain atrophy as a non-response predictor to interferon-beta in relapsing-remitting multiple sclerosis.

Abstract Background: Several predictors for treatment failure to interferon-beta (IFN-beta) have been proposed; however, brain atrophy has not been well studied. Methods: In this prospective and longitudinal study, all consecutive relapsing–remitting multiple sclerosis (RRMS) patients treated with sc IFN-beta-1a were included. Confirmed disability progression or a new relapse between weeks 48 and 144 after beginning with IFN-beta was considered as treatment non-response. EDSS progression, relapses, number of active lesions at 1 year (new or enlarging T2-weighted plus gadolinium-enhancing lesions, categorized in > 2 or ≤ 2), and brain parenchymal fraction (%BVC) volume change within the initial year of treatment were used as predictive factors. Cox regression model was adjusted for age, gender, and disease duration. Results: Seventy-one patients were included (71·8% female) with a follow-up of 144 weeks. Thirty-four (48%) fulfilled criteria of non-response to IFN-beta treatment. The model showed: (1) relapses+disability progression: HR  =  4·6, 95% IC: 3·1–6·7 (P < 0·001); (2) relapses+BVC decrease: HR  =  4·1, 95% IC: 3·2–7·3 (P  =  0·001); (3) relapses+disability progression+new active lesions: HR  =  10·1, 95% IC: 7·1–15·2 (P < 0·001); and (4) relapses+disability progression+new active lesions+BVC decrease: HR  =  14·4, 95% IC: 11·4–21·2 (P < 0·001). Conclusions: Adding BVC measures to previously described predictive failure factors may increase sensitivity to early identify non-responder patients to IFN-beta-1a in the second and third years of therapy.

Brain atrophy in clinically isolated syndrome

INTRODUCTION Previous reports have shown that brain atrophy appears early in the course of multiple sclerosis (MS). The aim of the present study was to evaluate whether brain atrophy already exists in clinically isolated syndrome (CIS) by comparing with a control sample. METHODS Patients with CIS were included prospectively from June 2008 to June 2009. A control group of healthy persons, matched by age and gender with CIS, was also included during the same period of time. An automated analysis tool, SIENAX, was used to obtain total brain volume (TBV), gray matter volume (GMV) and white matter volume (WMV). Mann-Whitney U test was used to analyze the data. RESULTS Twenty CIS patients and 30 healthy controls were included (8 vs. 17 females, p=0.11). Mean age for CIS was 35 ± 6 years vs. 34.4±5 in controls (p=0.61). Mean EDSS in CIS was 1.1 ± 0.5. Eighteen patients with CIS (90%) had abnormal baseline MRI. The TBV in CIS was 1.6.l ± 0.22.l × 106 vs.1.65 ± 0.15 × 106 in controls (p=0.005), the GMV in CIS was 0.58 ± 0.05 × 106 vs. 0.67 ± 0.03 × 106 in controls (p ≤ 0.001) and the WMV in CIS was 1 ± 0.1 × 106 vs. 1.12 ± 0.02 × 106 in controls (p=0.03). CONCLUSIONS This is the first study dealing with brain atrophy in a CIS sample from Latin America in which brain atrophy, mainly grey matter atrophy, was shown in early stages of the disease compared with healthy individuals.

Atypical hemorrhagic presentation of a fourth ventricle subependymoma: case report.

To present a case of a fourth ventricle subependymoma (SE) with a spontaneous acute subarachnoid intra-cisternal bleeding. A 33-year-old man was admitted with 5 days history of oppressive occipital headache and neck pain without additional neurological focus. Unenhanced computed tomography (CT) scan demonstrated an isointense mass located in the fourth ventricle with a spontaneously hyperdense acute extratumoral hemorrhage in the cisterna magna. Contrast-enhanced magnetic resonance imaging (MRI) revealed a well-delimitated non-enhanced tumor, hypointense on T1-weighted and hyperintense on T2-weighted images, involving the floor of the fourth ventricle and extending caudally into the cervical spinal canal via foramen magnum. Intraoperative, a large blood clot was removed and a macroscopically hypovascularlesion was completely excised from the right lateral recess and the floor of the fourth ventricle. Intra and postoperative immuno-histopathological examination revealed a SE. The patient has a normal postoperative course and was discharged in the fifth postoperative day. A 10-month postoperative MRI study confirmed a complete tumor resection. Symptomatic SEs should be surgically treated emphasizing the urgency in the presence of hemorrhage. The interest of this case is to demonstrate that infratentorial SEs although extremely rare, might present with acute subarachnoid bleeding.

Brain atrophy at onset and physical disability in multiple sclerosis

UNLABELLED The aim of this study was to investigate if brain atrophy in multiple sclerosis (MS) patients during the disease onset predicts long term disability. METHODS MS patients with follow-up time of at least 7 years from disease onset and with baseline and second magnetic resonance 12 months later were included to measure brain atrophy. Expanded Disability Status Scale (EDSS) was categorized in three groups, EDSS=0, EDSS=1 and 2.5 and EDSS>2.5, and used as disability measure. RESULTS Twenty-six patients were included. Mean atrophy during the first year in patients that reached an EDSS≥3 was -0.76±0.45 %, in patients with an EDSS between 1 and 2.5 was -0.59±0.56, while in patients with an EDSS of 0 it was -0.38±0.42 (p=0.003). DISCUSSION Brain atrophy rates during the first year of disease were predictive of disease progression in our population.

Restricted diffusion in a ring-enhancing mucoid metastasis with histological confirmation: case report.

We present a case of restricted diffusion in a ring-enhancing cerebellar metastasis in a 58-year-old man. Diffusion imaging showed restriction with low apparent diffusion coefficient values within the cavity. Diagnosis of abscess was suggested based on radiological findings. A suspicious lung nodule was found in the systemic evaluation, and histological examination of the brain lesion confirmed metastatic adenocarcinoma with mucoid content confirmed by further specific pathological tests. We discuss the reason of diffusion findings and the importance of the correct interpretation of this technique in a clinical situation. Our case confirms previous hypothesis about restricted diffusion related to mucoid content in metastasis.

Brain structural changes in patients in the early stages of multiple sclerosis with depression

Abstract Some studies suggest an inflammatory mechanism associated with the presence of depression in multiple sclerosis (MS); however, there is little data concerning these findings. The purpose of this study was to investigate the presence of brain structural changes in patients with MS and depression and to compare them with patients suffering from MS without depression and healthy controls. Methods: A case-control study that included patients with relapsing-remitting MS (RRMS) defined by validated criteria, over 18 years of age, with less than three years from disease onset, EDSS ≤ 3, with no history of previous depression and under immunomodulatory treatment with interferon beta, if any. A control group paired by age and gender was also included. Patients were clinically assessed to determine the presence of depression. Demographic clinical and structural aspects of parameters from the scan, such as lesion volume, total brain volume (TBV), white matter volume (WMV), neocortical gray matter volume (NGMV), and fractional anisotropy (FA) were analyzed. Results: Sixty-five individuals were enrolled: 20 healthy controls, 22 patients with MS without depression, and 23 patients with MS with depression. Patients with MS and depression showed a lower TBV (P = 0.01), NGMV (0.01) together with an increase in lesion burden in T2 (P < 0.01) but not in T1 (P = 0.09) and no differences in global FA among groups (P = 0.23) and in WMV (P = 0.12). Conclusion: Patients with RRMS and depression had a reduced total brain volume and a significantly increased lesion burden at T2 MR than patients with RRMS without depression.

Diferencias en la tasa de atrofia global y regional y del volumen lesional entre género en esclerosis múltiple

INTRODUCTION Previous studies showed gender-associated clinical and MRI differences in multiple sclerosis (MS) evolution. However, only few studies were done with non conventional MRI techniques and no one was done in a South American MS population. The aim of this study was to investigate gender differences according to nonconventional MRI measures in patients with MS from Buenos Aires, Argentina. METHODS Relapsing-remitting MS patients (RRMS) with at least 6 years of follow up and an MRI at onset and at 6 years were included. Patients were assessed using nonconventional MRI measures: total brain volume (TBV), neocortical grey brain volume (GBV), white brain volume (WBV), lesion load (LL), % of brain volume change between onset and year 6 (% BVC) and regional brain volume change. Gender-related MRI differences were investigated using general linear model analysis. RESULTS The 45 patients were included (25 female). Mean follow up time was 7.3 ± 0.2 years. No differences in age, EDSS at onset, DMD treatment, TBV, GBV, WBV neither LL were found between gender at baseline. Six years later, males showed a decrease in TBV (P=.002) and GBV (P ≤ 0.001) and an increase in LL (P=.02) and % BVC (P<.001) vs. females. Female patients showed a decrease in the volume of frontal subcortical region. DISCUSSION This is the first study showing differences in brain volume changes between gender in MS patients from South America. Future studies will confirm our initial findings.

Cervical chordoma with moderate bone impairment in a child. Answer to October e-quid

A 4-year-old boy, without personal antecedents, born at term after a normal pregnancy, presented progressive right hemiparesis over one month. He was referred for a brain and medulla MRI (Fig. 1), completed by a CT scan (Fig. 2). The diffusion sequence was negative. ଝ Here is the answer to the case previously published in the n o 10/2012. As a reminder we publish again the entire case with the response following.

NR-WS-38 Lymphomes cerebraux : Interet de la spectroscopie par resonance magnetique

Objectifs Montrer l’apport de la Spectroscopie par Resonance Magnetique (SRM) dans le prise en charge des lymphomes cerebraux. Mettre en relief l’importance de cette technique pour aider a etablir le diagnostic de cette pathologie, qui oblige le chirurgien a modifier la strategie chirurgicale et choisir la biopsie cerebrale. Materiels et methodes Nous presentons 6 cas evalues dans notre hopital avec SRM. Les patients presentaient des cephalees et d’autres symptomes cliniques non specifiques, en fonction de la topographie de la tumeur. L’IRM n’a pas ete concluante. L’une des tumeurs etait un lymphome systemique-non diagnostiquee jusque la-avec une localisation cerebrale, et les autres etaient des lymphomes cerebraux primitifs. Resultats Sur la SRM, les metabolites suivants ont ete constates : les pics de choline et de lipides etaient les plus importants. Le pic de lipides a ete identifie comme le metabolite dominant dans certains des cas, en particulier dans les sequences a TE court (30). Aucune difference de metabolites n’a ete constatee entre les formes primaires et la forme systemique de cette maladie. Conclusion Les lymphomes du systeme nerveux sont des tumeurs cerebraux avec un large eventail de manifestations radiologiques qui les rendent difficiles a caracteriser avec les seules donnees de l’IRM conventionnelle. La SRM peut devenir utile en demontrant la presence des pics de choline et de lipides. Ce dernier pic sur une tumeur autrement solide et profonde, renforce le diagnostic presomptif de lymphome et doit alerter le chirurgien a changer la strategie therapeutique.