Childhood Multiple Sclerosis
And Allied DeMyelinative Diseases
Article in Japanese
Imai M, Tanaka M, Hamano S, Nara T, Maekawa K
No To Hattatsu 1999 Jan;31(1):44-7
Saitama Children's Medical Center, Division of Neurology,
PMID# 10025134; UI# 99149273
We report five cases of Multiple Sclerosis (MS) and three cases of Allied DeMyelinative diseases starting during childhood.
Three of the MS patients presented with atypical initial symptoms, such as Acute Encephalitis or Myelitis, making an early clinical diagnosis difficult.
OphthalMologic symptoms were noted in four of MS children, and in two with allied DeMyelinative Diseases.
Therefore, if a child shows Ophthalmologic symptoms (i.e. Optic Neuritis, OphthalMoplegia), Brain Magnetic Resonance Imaging (MRI) should be conducted for the differential diagnosis of MS and other DeMyelinative Diseases.
CerebroSpinal Fluid analysis is not useful for the initial diagnosis of MS.
Because Pleocytosis and increase of OligoClonal IgG Band in CerebroSpinal Fluid are seen in both MS and other DeMyelinative Disorders.
However, Neuron Specific Enolase (NSE) is slightly higher in the latter than in the former.
T2-weighted MRI of Multiple Sclerosis showed multiple high intensity areas in the White Matter of the Cerebrum and Cerebellum, Capsula Interna, and Crus Cerebri, etc.
Most of these lesions were clinically silent, being characteristic of MS.
In two MS cases, however, initial MRI revealed no abnormal findings. Thus, the diagnosis of MS can not be made by initial MRI only.
Retinal Venous Sheathing And The Blood-Retinal Barrier In Multiple Sclerosis
Birch MK, Barbosa S, Blumhardt LD, O'Brien C, Harding SP
Arch Ophthalmol 1996 Jan;114(1):34-9
Royal Liverpool England Univ Hospital, St Paul's Eye Unit,
PMID# 8540848; UI# 96133210
To assess the temporal relations among Retinal appearance, disruption of the Blood-Retinal Barrier, clinical subgroup, disease course, and disruption of the Blood-Brain Barrier in Multiple Sclerosis.
A 6-month prospective study involving monthly clinical Ocular Examinations, Color Fundus Photography, Fundus Fluorescein Angiograms.
And Magnetic Resonance Brain Scans with Gadolinium-Diethylenetriamine-Pentaacetic Acid (Gd-DPTA) enhancement.
Setting & Patients
University-based Ophthalmology and Neurology departments. Twenty-three patients with Relapsing/Remitting, Primary/Progressive, or Secondary/Progressive Multiple Sclerosis.
Retinal venous sheathing was seen in six patients.
The appearances observed included focal Venous sheathing, diffuse Venous sheathing, sheathing centered on sites of ArterioVenous crossover, and focal PeriVenous hemorrhage.
Arteriolar sheathing was also observed in one patient. Venous leakage on Fundus Fluorescein Angiogram was detected in three patients, all of whom also had sheathing.
The following three patterns of disruption of the Blood-Retinal Barrier were seen on Fundus Fluorescein Angiogram:
- Focal leakage
- Extensive leakage
- Very late wall staining
In one patient, the leakage was transitory.
No correlations were observed between Ophthalmologic features and Multiple Sclerosis clinical subgroup, disease course, or the number of new (Gd-DTPA-enhancing) lesions on Magnetic Resonance Imaging.
Disruption of the Blood-Retinal Barrier, like the more frequent disruption of the Blood-Brain Barrier.
Seen on Magnetic Resonance Imaging, is often unrelated to clinical Neurologic relapses and occurs with apparently similar frequency in different patients independent of clinical disease course.
Periphlebitis Retinae, Uveitis And Cystoid Maculopathy In A Patient With Multiple Sclerosis
Spraul CW, Lang GE
Klin Monatsbl Augenheilkd 1999 Dec;215(6):373-5
A 44-year-old woman has a history of Multiple Sclerosis since 20 years. Besides recurrent numbness she had many instances of Optic Nerve Neuritis which has led to a pronounced Optic Atrophy on her left eye.
Additionally, she has developed recurrent Iridocyclitis on her right eye. This was the reason why she was referred to our outpatient department for evaluation.
Ophthalmic Examination revealed an Iridocyclitis associated with a multifocal Retinal Periphlebitis and severe Cystoid Macular Edema in her right eye.
Patients with Multiple Sclerosis develop in approximately 30% of cases Retinal Periphlebitis which may rarely be associated with Anterior Uveitis or Cystoid Macular Edema as observed in our patient.
VitreoRetinal Traction Syndrome In Multiple Sclerosis
Hochwarter A, Prainer C, Binder S, Stolba U
Ophthalmologe 2004 Feb;101(2):153-7
Augenabteilung, Krankenanstalt Rudolfstiftung und Ludwig-Boltzman-Institut fur Retinologie und biomikroskopische Laserchirurgie, Vienna
From January to December 2001, 89 patients with Multiple Sclerosis (MS) were treated in our hospital; 24 of them were diagnosed for the first time.
All patients underwent a complete Ophthalmologic examination including a three-mirror contact lens examination when Photopsias were found or the disease was diagnosed primarily.
Two patients showed VitreoRetinal Tractions with signs of periphlebitis before clinical-neurological manifestation of Multiple Sclerosis.
The third patient, in whom the disease had been known for years, showed distinct NeoVascularizations, Vasculitis, and recurrent Vitreous Hemorrhages.
High-dose steroid therapy resulted in stabilization of the Retinal situation in one patient, but the Tractions remained unchanged.
Additional laser coagulation in the second patient achieved stabilization and reduction of the Tractions. A Pars Plana Vitrectomy led to stabilization of the Retinal proliferation in the third patient.
The VitreoRetinal Traction syndrome is associated with MS and can precede its clinical-Neurological manifestation.
The good results after argon laser coagulation and VitreoRetinal surgery suggest a Vascular pathogenesis of these Tractions.
Ge Y, Zohrabian VM, Grossman RI
Arch Neurol 2008 Jun;65(6):812-6
Center for Biomedical Imaging, New York University School of Medicine, Department of Radiology, 650 First Ave, Room 615, New York, NY 10016, USA
Although the role of Vascular pathology in Multiple Sclerosis (MS) lesions was suggested long ago, the derivation of these lesions from the Vasculature has been difficult to assess in vivo.
UltraHigh-field (eg, 7-T [Tesla]) Magnetic Resonance Imaging (MRI) has become a tool for assessing Vascular involvement in MS lesions owing to markedly increased image resolution and susceptibility contrast of Venous blood.
To describe the PeriVenous association of MS Lesions on high-resolution and high-contrast 7-T susceptibility-sensitive MRI.
Design, Setting & Patients
Case study, University hospital. Two women with clinically definite Relapsing/Remitting MS.
We demonstrated markedly enhanced detection of unique MicroVascular involvement associated with most of the visualized MS lesions with abnormal signals on and around the Venous Wall on 7-T compared with 3-T MRI.
These findings, which have never been shown on conventional fields of MRI, not only allow for direct evidence of Vascular pathogenesis in MS in vivo.
But, also have important implications for monitoring lesion activity and therapeutic response.