Related Experiment Videos
A longitudinal MR study of the presymptomatic phase in a patient with clinically definite multiple sclerosis
G Mastronardo1, M A Rocca, G Iannucci
1Department of Neuroscience, Scientific Institute Ospedale San Raffaele, University of Milan, Italy.
Abstract:
We describe the dynamics and the nature of the presymptomatic phase of multiple sclerosis (MS) in a patient for whom MR abnormalities suggestive of MS were found before the development of clinical symptoms. The patient was monitored with serial monthly MR imaging of the brain and spinal cord for 5 months. Disease activity during the presymptomatic phase showed imaging characteristics comparable to that of early relapsing-remitting MS in terms of enhancing lesions, duration of enhancement, and new lesions depicted by T2-weighted imaging. Measurements derived from magnetization transfer imaging suggested that the amount and degree of tissue destruction within and outside the lesions revealed by T2-weighted imaging were mild. This, together with the fact that only one of the 43 new lesions that developed during the presymptomatic phase was located in a neurologically eloquent area, may be the reason why, for a relatively long period, the patient had no clinical manifestations of MS despite the marked MR findings of disease activity.
Insights
The presymptomatic phase of multiple sclerosis (MS) shows significant MRI activity similar to early MS, but with mild tissue damage. This explains the delayed clinical symptoms despite active disease.
Area of Science:
- Neurology
- Radiology
- Neuroimmunology
Background:
- Understanding the presymptomatic phase of multiple sclerosis (MS) is crucial for early intervention.
- This study investigates the imaging characteristics of MS before clinical symptom onset.
Observation:
- A patient with suspected MS underwent monthly MRI scans of the brain and spinal cord for five months.
- Presymptomatic disease activity included enhancing lesions and new T2-weighted lesions, comparable to early relapsing-remitting MS.
Findings:
- Magnetization transfer imaging indicated mild tissue destruction despite significant MRI-detected disease activity.
- Most new lesions (43) occurred in non-eloquent areas, contributing to the lack of early clinical symptoms.
Implications:
- The findings highlight that substantial MRI-detectable MS activity can precede clinical diagnosis.
- This underscores the potential for early detection and monitoring of MS through advanced neuroimaging techniques.