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Multiple sclerosis differential diagnosis

Caterina Lapucci, Laura Saitta, Giulia Bommarito, Maria Pia Sormani, Matteo Pardini, Laura Bonzano, Giovanni Luigi Mancardi, Claudio Gasperini, Antonio Giorgio, Matilde Inglese, Nicola De Stefano, Luca Roccatagliata
OBJECTIVE: To evaluate in clinically isolated syndrome (CIS) and migraine with aura (MA) how the number of periventricular lesions (PVLs) detected at MRI influences diagnostic performance when the Magnetic Resonance Imaging in Multiple Sclerosis (MAGNIMS) or the 2017 revised criteria are applied. METHODS: In this retrospective study, white matter hyperintensities (WMH) of 84 patients with MA and 79 patients with CIS were assessed using manual segmentation technique...
March 8, 2019: Neurology
Todd A Hardy
PURPOSE OF REVIEW: To review the clinical findings, differential diagnosis, treatment and outcome of pseudotumoral demyelinating lesions including tumefactive demyelination and Baló's concentric sclerosis. RECENT FINDINGS: MRI findings, such as dynamic restricted diffusion changes at the edge of pseudotumoral lesions help to discriminate atypical demyelination from key differential diagnoses, and together with histopathological data, indicate that tissue hypoxia may be important aetiologically...
February 21, 2019: Current Opinion in Neurology
Sun-Uk Lee, Hyo-Jung Kim, Jae-Hwan Choi, Jeong-Yoon Choi, Ji-Soo Kim
This study aimed to define the clinical features and involved structures that aid in differentiation of neuromyelitis optica spectrum disorder (NMOSD) from multiple sclerosis (MS) involving the brainstem and cerebellum. We analyzed the clinical and ocular motor findings, and lesion distribution on brain MRIs in 42 patients with MS (17 men, mean age ± SD = 37 ± 12) and 26 with NMOSD (3 men, mean age ± SD = 43 ± 15) that were recruited from two university hospitals in South Korea (whole study population)...
March 2, 2019: Cerebellum
Yaou Liu, Di Dong, Liwen Zhang, Yali Zang, Yunyun Duan, Xiaolu Qiu, Jing Huang, Huiqing Dong, Frederik Barkhof, Chaoen Hu, Mengjie Fang, Jie Tian, Kuncheng Li
OBJECTIVE: To develop and validate an individual radiomics nomogram for differential diagnosis between multiple sclerosis (MS) and neuromyelitis optica spectrum disorder (NMOSD). METHODS: We retrospectively collected 67 MS and 68 NMOSD with spinal cord lesions as a primary cohort and prospectively recruited 28 MS and 26 NMOSD patients as a validation cohort. Radiomic features were extracted from the spinal cord lesions. A prediction model for differentiating MS and NMOSD was built by combining the radiomic features with several clinical and routine MRI measurements...
February 15, 2019: European Radiology
José Manuel Sánchez-Villalobos, Amaya Jimeno-Almazán, Carmen López-Peña, Esther Hernández-Hortelano, Antonio Martínez-Francés, José Antonio Pérez-Vicente
Erdheim-Chester disease (ECD) is a rare form of non-Langerhans cell histiocytosis that presents potential impairment of the central nervous system (CNS). Frequent CNS impairment makes ECD a disease worth considering in the differential diagnosis of multiple sclerosis (MS). We report the case of a patient initially diagnosed with relapsing-remitting MS with an atypical course who developed ECD during the disease progression. Given the patient's clinical-radiological characteristics, two diagnostic possibilities were proposed: the coexistence of both diseases or a new presentation of ECD mimicking MS...
February 6, 2019: Multiple Sclerosis and related Disorders
Robyn Thom, David A Silbersweig, Robert J Boland
Major Depression, as well as other depressive disorders, are commonly comorbid with other medical illnesses, particularly chronic and systemic medical illnesses. The cooccurrence of the disorders is so common that it challenges our notions of the meaning of comorbidity and our desire to neatly separate psychiatric and medical illnesses. The overlap between symptoms of physical illness and the neurovegetative symptoms of major depression and the initial normative emotional response to physical illness add to the challenge of accurate diagnosis and timely treatment of depression in the medically ill...
February 1, 2019: Psychosomatic Medicine
Virginia Mato-Abad, Andrés Labiano-Fontcuberta, Santiago Rodríguez-Yáñez, Rafael García-Vázquez, Cristian R Munteanu, Javier Andrade-Garda, Angela Domingo-Santos, Victoria Galán Sánchez-Seco, Yolanda Aladro, Mª Luisa Martínez-Ginés, Lucía Ayuso, Julián Benito-León
INTRODUCTION: The unanticipated magnetic resonance imaging (MRI) detection in the brain of asymptomatic subjects of white matter lesions suggestive of multiple sclerosis (MS) has been named as radiologically isolated syndrome (RIS). As the difference between early MS (i.e., clinically isolated syndrome [CIS]) and RIS is the occurrence of a clinical event, it should be logical to improve detection of subclinical form without interfering with MRI as there are radiological diagnostic criteria for that...
February 3, 2019: European Journal of Neurology: the Official Journal of the European Federation of Neurological Societies
M J Wendebourg, S Nagy, T Derfuss, K Parmar, R Schlaeger
Immune-mediated myelopathies are a heterogeneous group of inflammatory spinal cord disorders including autoimmune disorders with known antibodies, e.g. aquaporin-4 IgG channelopathy or anti-myelin oligodendrocyte glycoprotein-associated myelitis, myelopathies in the context of multiple sclerosis and systemic autoimmune disorders with myelopathy, as well as post-infectious and paraneoplastic myelopathies. Although magnetic resonance imaging of the spinal cord is still challenging due to the small dimension of the cord cross-section and frequent movement and susceptibility artifacts, recent methodological advances have led to improved diagnostic evaluation and characterization of immune-mediated myelopathies...
January 29, 2019: Journal of Neurology
Laura Thompson, Helen Ford, Amanda Stroud, Anna Madill
OBJECTIVE: Our aim is to understand how to facilitate the job retention of employees with chronic illness. We focus on multiple sclerosis (MS) as a criterion chronic illness. DESIGN: An opportunity sample of 20 individuals of working age (13 female; 7 male) were recruited who had been in paid employment for over 28 months with a concurrent diagnosis of MS. Participants took part in one of three focus groups with a topic guide comprising keywords: work, coping, performance, support, future, expectations, sharing and symptoms...
January 29, 2019: Psychology & Health
Paolo Cameli, Elena Bargagli, Laura Bergantini, Rosa Metella Refini, Maria Pieroni, Piersante Sestini, Paola Rottoli
Fractional exhaled nitric oxide (FeNO) is a non-invasive and reproducible marker of nitrosative stress and lung inflammation. More recently, FeNO has been proposed as a marker of severity of idiopathic pulmonary fibrosis (IPF) and systemic sclerosis associated ILD.
 AIM AND OBJECTIVES: to evaluate the role of FeNO in the diagnostic pathway of ILDs.
 METHODS: According to ERS guidelines for exhaled biomarkers in lung diseases, FeNO at multiple flow-rates (50-100-150 and 350 ml/s) and alveolar concentration of NO (CaNO) were collected in 60 healthy controls and 134 patients affected by ILD: 50 with IPF, 19 with fibrotic non-specific interstitial pneumonia (NSIP), 19 with chronic hypersensitivitis pneumonia (cHP) and 46 with connective tissue disease related ILD (CTD-ILD)...
January 28, 2019: Journal of Breath Research
Joeri de Hoog, Willem A Dik, Lucy Lu, Kim C Heezen, Josianne C Ten Berge, Sigrid M A Swagemakers, Peter J van der Spek, Jacques J M van Dongen, Vincent H J van der Velden, Aniki Rothova, Anton W Langerak
PURPOSE: Primary vitreoretinal lymphoma [(P)VRL]) is a rare malignancy of the eye localized in the retina, vitreous or choroid. Here, we aim to determine the value of the combination of innovative diagnostic methods for accurate differentiation between (P)VRL and non-(P)VRL in patients with suspect uveitis or vitritis. METHODS: Multicolour flow cytometric immunophenotyping of cells in the vitreous samples was performed using the EuroFlow small sample tube. Additionally, cytokines/chemokines and growth factors were measured in the vitreous specimens using a multiplex immunoassay...
January 27, 2019: Acta Ophthalmologica
Zina-Mary Manjaly, Neil A Harrison, Hugo D Critchley, Cao Tri Do, Gabor Stefanics, Nicole Wenderoth, Andreas Lutterotti, Alfred Müller, Klaas Enno Stephan
Fatigue is one of the most common symptoms in multiple sclerosis (MS), with a major impact on patients' quality of life. Currently, treatment proceeds by trial and error with limited success, probably due to the presence of multiple different underlying mechanisms. Recent neuroscientific advances offer the potential to develop tools for differentiating these mechanisms in individual patients and ultimately provide a principled basis for treatment selection. However, development of these tools for differential diagnosis will require guidance by pathophysiological and cognitive theories that propose mechanisms which can be assessed in individual patients...
January 25, 2019: Journal of Neurology, Neurosurgery, and Psychiatry
M C González-Oria, M Márquez-Coello, J A Girón-Ortega, J Argente, M Moya, José-Antonio Girón-González
Analysis of gut barrier status, monocyte and lymphocyte activation and T regulatory (Treg) cells at diagnosis before and after therapy, in patients with multiple sclerosis (MS). Analysis of differential effects of interferon beta (IFN-β), glatiramer acetate (GA) and natalizumab. Thirty-five patients with untreated MS were included. Gut barrier status (serum concentrations of intestinal fatty acid binding protein), monocyte (serum levels of soluble CD14, soluble CD163 and interleukin 6) and T lymphocyte activation (CD4 + DR+ and CD8 + DR+) and Treg (CD4 + CD25highFoxP3+) cells were analyzed...
January 16, 2019: Journal of Neuroimmune Pharmacology: the Official Journal of the Society on NeuroImmune Pharmacology
Subhanudh Thavaraputta, Suzanne Graham, Ana M Rivas Mejia, Joaquin Lado-Abeal
Somatostatinomas are rare neuroendocrine tumours, mostly located in the pancreas or duodenum, with an estimated incidence of 1 in 40 million. Duodenal somatostatinomas (DSs) are usually found in association with neurofibromatosis type 1 (NF1), tuberous sclerosis and Von Hippel-Lindau syndrome. Gastrointestinal stromal tumours (GIST) have also been described in NF1, but the association with somatostatinoma is very uncommon. We report the case of a patient with NF1 who presented with obstructive jaundice due to multiple firm nodules around the ampulla of Vater...
January 10, 2019: BMJ Case Reports
Caiyun You, Lina Ma, Stephen D Anesi
Aim: To report a case of bilateral papillitis as the initial ophthalmologic presentation in a patient with complex medical history and multisystemic symptoms, eventually revealing a diagnosis of sarcoidosis. Methods: Retrospective interventional case report. Report: A 54-year-old Caucasian woman presented with bilateral decreased vision, photophobia and eye pain for a month. She was referred for evaluation of disc edema with questionable history of vitritis...
March 2019: American Journal of Ophthalmology Case Reports
B Ceronie, O C Cockerell
Acute disseminated encephalomyelitis (ADEM) is an uncommon, autoimmune, demyelinating disorder of of the central nervous system. It is rare in adults beyond 65 years. Here, we describe a novel presentation following urological surgery. Using illustrative features from our case study, we describe some of the clinical features, aetiologies, diagnostic uncertainties and pathogenic mechanisms of the disease. A 69 year old gentleman underwent transurethral resection of the prostate. He then developed confusion, unsteadiness, behavioural disturbance and left-sided hemiparesis...
March 2019: ENeurologicalSci
Eirini I Rigopoulou, Sofia Gyftaki, Pinelopi Arvaniti, Vana Tsimourtou, George K Koukoulis, Georgios Hadjigeorgiou, George N Dalekos
BACKGROUND: Development of autoimmune hepatitis (AIH) has been sporadically reported in patients with multiple sclerosis (MS) either concurrently or after treatment with immunomodulatory drugs, including interferon-beta (IFN-β) and steroids. AIM: To report a large cohort of 14 patients with MS diagnosed with AIH during an assessment of deranged liver function tests (LFTs). PATIENTS AND METHODS: From 2005 to 2017, we prospectively identified 14 (13 women) patients with MS who suffered also from AIH after investigation in our department for the presence of deranged LFTs...
December 26, 2018: Clinics and Research in Hepatology and Gastroenterology
Frederike C Oertel, Hanna G Zimmermann, Alexander U Brandt, Friedemann Paul
Multiple Sclerosis (MS) is the most common chronic autoimmune neuroinflammatory condition in young adults. It is often accompanied by optic neuritis (ON) and retinal neuro-axonal damage causing visual disturbances. Optical coherence tomography (OCT) is a sensitive non-invasive method for quantifying intraretinal layer volumes. Recently, OCT not only showed to be a reliable marker for ON-associated damage, but also proved its high prognostic value for functional outcome and disability accrual in patients with MS...
December 27, 2018: Expert Review of Neurotherapeutics
Ibrahim Omerhodžić, Almir Džurlić, Dino Lisica, Nevena Mahmutbegović, Maida Nikšić, Nurija Bilalović, Enra Suljić
OBJECTIVE: We present a case of relapsing tumefactive demyelination in a young female patient, that posed a real diagnostic challenge, with a heterogeneous clinical picture, atypical for multiple sclerosis (MS) presentation, and neuroradiological manifestations with a high suspicion of neoplastic diseases. CASE REPORT: An 18-year old female patient presented to our Neurosurgical Out-patients' Clinic with symptoms atypical for multiple sclerosis, unremarkable neurological deficit, one tumefactive lesion on MRI, followed by relapse and another two lesions within a period of six months...
November 2018: Acta Medica Academica
Anna Zacharzewska-Gondek, Anna Pokryszko-Dragan, Tomasz Maciej Gondek, Anna Kołtowska, Ewa Gruszka, Sławomir Budrewicz, Marek Sąsiadek, Joanna Bladowska
AIMS: The objectives of the study were to assess the usefulness of measurements of apparent diffusion coefficient (ADC) in normal appearing white and grey matter (NAWM, NAGM) in differential diagnosis between patients with hyperintense demyelinating plaques in the course of multiple sclerosis (MS) and other conditions presenting white matter hyperintensities (WMHs), as well as to evaluate the relationship between clinical data and ADC values in MS patients. MATERIAL AND METHODS: The study comprised 66 patients with MS before treatment, 66 patients with WMHs and 64 control subjects (control group, CG), who underwent MRI (magnetic resonance imaging) examination including diffusion weighted imaging (DWI) with a 1...
December 14, 2018: Journal of the Neurological Sciences
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