Palmetto Health Richland August 2008 35 yo AAF presents with confusion, agnosia, apraxia, right-sided lower extremity paresis Symptoms first noticed 2 hours ago CT scan- no blood MRI- single hyperintense lesion in the left periventricular white matter Started IV steroids, ran a panel of CSF & blood studies 3 days later- Symptoms resolved Diagnosed with Multiple Sclerosis
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35 yo AAF presents with confusion, agnosia, apraxia, right-sided lower extremity paresis Symptoms first noticed 2 hours ago CT scan- no blood MRI-
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Palmetto Health Richland August 2008
35 yo AAF presents with confusion, agnosia, apraxia, right-sided lower extremity paresis
Symptoms first noticed 2 hours ago CT scan- no blood MRI- single hyperintense lesion in the left
periventricular white matter Started IV steroids, ran a panel of CSF &
blood studies 3 days later- Symptoms resolved Diagnosed with Multiple Sclerosis
The Imaging of Multiple Sclerosis* Utility of MRI* Differential of White Matter Lesions* Future direction of neuroradiology
Jessica Floyd, M4
What is Multiple Sclerosis? Chronic Inflammatory demyelinating disease of
the CNS 2nd-3rd decade of life (“belongs to the climax of
life”) 2:1 Female predominance 250-350,000 people with MS in the US Cyclical inflammatory reactions followed
by remission of symptoms and variable recovery Relapsing-Remitting- 80% Primary Progressive- 20%; closer incidence M:F Secondary Progressive
Charcot’s description
First described by Charcot in 1835 Patient history, physical exam, autopsy Salpetriere (1865) to the United States
Blood vessel at the center of each lesion Preserved axis cyllinder Atrophy of the medullary sheath Types:
immunocompromised Largest differential concerns Vascular versus MS
Normal Aging & Fazeka’s
Virchow Robin Spaces
Vascular vs Multiple Sclerosis
Vascular disease vs Multiple Sclerosis
66 yo Male T2 HyperintensitiesNone being OvoidFew Periventricular LesionsNo Juxtacortical lesions
Vascular vs. Multiple Sclerosis
Criteria for Diagnosis of MS
Since MRI revolutionized the diagnosis of MS, needed specific criteria
Crux of the Dx is demonstrating attacks of neurologic dysfunction are separated in space and time Clinical criteria* pt hx, PE findings, Laboratory Criteria* oligoclonal bands,
IgG index MRI * 2001 McDonald Criteria, 2005
revised
Diagnostic Criteria
Dissemination in TIME- 3 months
One episode, treat or not to treat?
Cannot diagnose MS on MRI alone- need the clinical exam & history
However, MRI can now show us what even a vigorous clinical exam cannot
Revolutionizing treatment treat earlier
Mild cognitive deficits discovered earlier
42 yo woman with MS, no Sx
Coming in the future…
MR Spectroscopy- N-acetyl aspartate, Lactate
Diffusion Tensor Imaging Able to pick up on lesions not yet
detectable on MRI Ability to give you information on
precisely how damaged the lesion is compared to other lesions
Diffusion Tensor Imaging
Diffusion Tensor Imaging
o3-D water diffusion oMean Diffusivity- overall diffusionoFractional anisotropy- amount of elongatedness of diffusionoColorized primary eigenvector maps- illustrate different directions of the primary fiber tracto RED = L-Ro GREEN = Up-Downo BLUE = In-Out of page