Multiple sclerosis - white spots and red flags - part 2 - Mimics and Variants
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- čas přidán 2. 08. 2024
- Demyelinating disease is a common situation we encounter in neuroradiology, and properly diagnosing and tracking it using MRI is a key skill for neuroradiologists. In this second part of the lecture, Dr. Michael Hoch gives us some tips about other causes of white matter lesion, and information we can use to make our imaging diagnosis of multiple sclerosis more specific.
Clinical history has an important role in determining how specific imaging findings are for multiple sclerosis. Some features may suggest that a patient does not have multiple sclerosis, such as if they are the wrong age (less than 20 or more than 50 years old), if they have abrupt swift progression, if they have systemic symptoms such as fever or weight loss, and if they have uncommon CNS symptoms such as a movement disorder or meningitis signs. MS lesions also usually occur in some specific locations, such as in the corpus callosum, temporal lobe, periventricular white matter, and juxtacortical white matter.
2:30 Mimics of Multiple sclerosis
So, what are some of the common mimics of MS?
Migraine - migraine is the most common cause of non-specific white matter abnormalities in young patients, occurring in more than 50% of patients with migraine
Chronic small vessel ischemia - more common with increasing age, and worsening with risk factors such as diabetes, hypertension, and smoking
CNS vasculitis - an inflammatory syndrome of the intracranial vessels. Be on the lookout if someone has a history of TIAs or thunderclap headache, or systemic symptoms.
Behcet's disease - a vasculitis most common in young males, characterized by brainstem involvement and oral ulcers
Susac syndrome - an autoimmune microangiopathy overlapping MS in age distribution. However, patients more often have a triad of encephalopathy, hearing loss, and visual changes. Corpus callosum involvement is more likely to be central.
CADASIL - an autosomal dominant syndrome characterized by frequent infarcts. Look out for the characteristic locations in the temporal poles, external capsules, and paramedian superior frontla lobes. It is also usually quite symmetric.
Other rarer mimics are Neuro-Sweets disease and Lyme disease, which can cause white matter abnormalities.
9:25 Variants of demyelinating disease
There are several common variants that you should know about across the demyelinating spectrum:
ADEM - acute disseminated encephalomyelitis - an autoimmune mediated and often self limited fulminant demyelinating process. May be related to a viral illness or vaccination.
Marburg disease - a clinically fulminant demyelinating disease usually affecting younger patients with a febrile prodrome.
Balo concentric sclerosis - a rare and monophasic demyelinating disease characterized by large lesions with alternating zones of demyelination/myelination
Tumefactive demyelinating lesions (TDL) - large and often fulminant demyelinating lesions that have mass effect and can mimic tumors. Perfusion imaging with low blood volumes can help differentiate from masses.
Neuromyelitis optica (NMO) - a demyelinating syndrome characterized by post-chiasmatic optic neuritis and long segment spine lesions. This is mediated by an aquaporin-4 antibody.
Progressive multifocal leukoencepalopathy (PML) - a JC virus mediated demyelinating lesion that occurs in immune suppressed patients. Usually has little or no enhancement and favors a subcortical location.
16:33 Summary
In summary, there are a couple of key things to keep in mind when evaluating potential demyelinating lesions:
Read the chart for clinical red flags
Look at the MRI for imaging red flags, like strokes, hemorrhages, cysts, findings that are too symmetric, subcortical, or normal
Remember that white matter lesions from migraine and microvascular disease are far more common that multiple sclerosis
NMO has differentiating features
PML is a rare complication of immune suppressing medications in MS patients
The level of this lecture is appropriate for radiology residents, radiology fellows, and trainees in other specialties who have an interest in imaging or treating patients with potential demyelinating diseases.
This video is part of a two part series on multiple sclerosis presented by Dr. Hoch .
If you haven't seen it already, go back and check out part 1 , in which Dr. Hoch discusses the key findings of demyelinating lesions.
Was waiting for that one .Thanks .
No problem 👍 Hope you liked it.
Thank you very much for these videos and for your effort!
Glad you like them!
Really great, surely will help me. Thanks a lot!
Glad to hear that! Thanks for checking out the video
Great series. look forward to more tutorials. Thumb it up.
Glad you like them!
EDUCATION IS KEY TO CHANGE!
Save MS Healthcare Facilitate make available research Cerebrospinal Blood flow Impacting Neurovascular & Cardiovascular Disease! #CCSVI is A congenital Science CONFIRMED recognized Medical condition CAUSATIVE MS Symptoms!
'New research published in Human Brain Mapping provides evidence of a shared neural mechanism that underlies sleep disturbance and mental disorders in preadolescents. The findings indicate that sleep disturbance and mental health problems are both related to the connectivity between and within two important brain networks.'
“I noticed the importance of sleep years ago when I read several papers about the immediate amyloid protein deposition in the brain after short-term sleep deprivation. Amyloid is neurotoxic waste in the brain and needs to be transported out by cerebrospinal fluid,” said study author Ze Wang, an associate professor of diagnostic radiology and nuclear medicine at the University of Maryland School of Medicine.'
What is the role of CCSVI Venous Hypertension Impacting proper/improved Cerebrospinal Blood Flow and amyloid plaques tau accumulation? #CCSVI
'Researchers at Karolinska Institutet in Sweden have compared how well different Alzheimer's biomarkers predict the progression of the disease and its effect on the memory. They found that early accumulation of tau proteins in the brain as measured by PET scanner was more effective at predicting memory impairment than biomarkers in the cerebrospinal fluid or amyloid plaque in the brain. The results are published in the journal Molecular Psychiatry.archers at Karolinska Institutet in Sweden have compared how well different Alzheimer's biomarkers predict the progression of the disease and its effect on the memory. They found that early accumulation of tau proteins in the brain as measured by PET scanner was more effective at predicting memory impairment than biomarkers in the cerebrospinal fluid or amyloid plaque in the brain. The results are published in the journal Molecular Psychiatry.'
EDUCATION IS KEY TO CHANGE!
Save MS Healthcare Facilitate make available research Cerebrospinal Blood flow Impacting Neurovascular & Cardiovascular Disease! #CCSVI is A congenital Science CONFIRMED recognized Medical condition CAUSATIVE MS Symptoms!
'New research published in Human Brain Mapping provides evidence of a shared neural mechanism that underlies sleep disturbance and mental disorders in preadolescents. The findings indicate that sleep disturbance and mental health problems are both related to the connectivity between and within two important brain networks.'
“I noticed the importance of sleep years ago when I read several papers about the immediate amyloid protein deposition in the brain after short-term sleep deprivation. Amyloid is neurotoxic waste in the brain and needs to be transported out by cerebrospinal fluid,” said study author Ze Wang, an associate professor of diagnostic radiology and nuclear medicine at the University of Maryland School of Medicine.'
What is the role of CCSVI Venous Hypertension Impacting proper/improved Cerebrospinal Blood Flow and amyloid plaques tau accumulation? #CCSVI
'Researchers at Karolinska Institutet in Sweden have compared how well different Alzheimer's biomarkers predict the progression of the disease and its effect on the memory. They found that early accumulation of tau proteins in the brain as measured by PET scanner was more effective at predicting memory impairment than biomarkers in the cerebrospinal fluid or amyloid plaque in the brain. The results are published in the journal Molecular Psychiatry.archers at Karolinska Institutet in Sweden have compared how well different Alzheimer's biomarkers predict the progression of the disease and its effect on the memory. They found that early accumulation of tau proteins in the brain as measured by PET scanner was more effective at predicting memory impairment than biomarkers in the cerebrospinal fluid or amyloid plaque in the brain. The results are published in the journal Molecular Psychiatry.'
I been told i have ms or a brain tumour as i have a solitary white spot on left frontal lobe so watching this has been interesting and better to compare my symptoms
I'm glad it has been helpful for you. Best of luck with your diagnosis and treatment.
This guy is too educated for me.. I’ll have to study medical terms first👍😘
Dr. Hoch is pretty smart but hope you can still learn a little something!
@@LearnNeuroradiology absolutely! Just wish I had a medical dictionary 😘
dope!!
Thanks! Glad you liked it!
What about “Wide-Bore” MRI? If it works just as well as the narrow type MRI why isn’t it the standard?
Despite the best attempts of the scanner manufacturers, wide bore MRI does not work as well as the standard type. It is harder to create an even magnetic field which can result in decreased image quality. It may take up more room and may cost more because of additional components to make up for the size difference.
In most cases, it may not make a difference and they have done a pretty good job of getting them as close as possible. Wide bore scanners are helpful for larger patients and patients with severe claustrophobia, which helps.
MS like symptoms since at least 2018 and i cannot get a doctor to help me
I'm sorry to hear. A neurologist with specialization in multiple sclerosis should be able to help determine if you have MS and what the next steps are
can you please a video on how to assess atrphy and aghing brain .Thanks .
Dr. Hoch is going to work on that one next.
Can people with migraines have spine lesions as well like MS?
hi, thanks a lot for the video although i have a question.
i dont understand how microinfarctions can produce leptomeningeal enhancements is there a known pathophysiological mechanism behind this?
Ah, well, anything that causes disruption of the blood brain barrier can cause leptomeningeal enhancement. In infarcts, there is damage to the vessel junctions and vessel walls themselves, and the contrast leaks out.
For MS diagnosis/treatment how much of the spinal cord should/can be scanned for lesions?
For initial diagnosis, the entire spinal cord (cervical and thoracic spine. the spinal cord stops at the bottom of the lumbar spine) is usually scanned at least once. Subsequent scanning is variable and may depend on symptoms and preference
Can you live normal with balo disease ???
Well, the prognosis varies but there are definitely treatments which can mitigate the disease and help you lead as normal life as possible. There will be challenges, of course, but your life isn't over.
@@LearnNeuroradiology Thanks a lot . I don’t know what type of inflammation I have, it’s similar to multiple sclerosis, but I don’t know what type it is. I saw the type Balo in my report, but the MRI show the opposite. The neurologist told me that to find it out, we have to wait two weeks and that’s why i’m here . Wish me luck and thank you again .
Good luck!
Are we dying
Yeah, we're all dying, just a little bit at a time
Can I send you my MRI results please, if so what’s your email or fb or Instagram
I'm sorry we don't really do that for several reasons. You need to talk about them with your doctor.