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Solitary hemispheric demyelination in acute disseminated encephalomyelitis: clinicoradiological correlation
Surendra Singh1, Mathew Alexander, Nathaniel Sase
1Department of Radiodiagnosis, Christian Medical College and Hospital, Vellore 632004, Tamilnadu, India. singhsurendra26@hotmail.com
Abstract:
We retrospectively studied 13 patients with solitary hemispheric demyelination in acute disseminated encephalo--myelitis (solitary-ADEM) to look for specific MRI features. Thirteen patients were subjected to routine MRI with varying initial clinical diagnosis, including demyelination, neoplasm, encephalitis and infarct. The provisional MRI diagnosis was based on lesion morphology, size, location, mass effect, effect on adjacent sulci, cisterns and gyral shape. On long repetition time (TR)/long echo time (TE) spin echo sequences, the lesions were heterogeneously hyperintense, and on short TR/short TE spin echo sequences, heterogeneously hypointense. Later, the provisional MRI diagnosis was corroborated with clinical parameters such as multimode-evoked potentials, electro--physiological studies and analysis of cerebrospinal fluid (CSF) in order to establish a definitive diagnosis. The diagnosis was established in all except one patient with tumour-like clinical and MRI features. The combination of MRI features and clinical parameters can establish a definitive diagnosis in the majority of cases, and this avoids a biopsy.
Insights
This study identified specific MRI features for solitary acute disseminated encephalomyelitis (ADEM). Combining MRI findings with clinical data aids definitive diagnosis, potentially avoiding invasive biopsies.
Area of Science:
- Neurology
- Radiology
- Neuroimmunology
Background:
- Acute disseminated encephalomyelitis (ADEM) can present with varied clinical and imaging findings.
- Solitary hemispheric demyelination is a challenging presentation of ADEM.
- Differentiating ADEM from other neurological conditions like neoplasms or infarcts is critical.
Purpose of the Study:
- To identify specific magnetic resonance imaging (MRI) features of solitary hemispheric demyelination in ADEM.
- To evaluate the utility of MRI in conjunction with clinical parameters for diagnosing solitary-ADEM.
- To assess if this combined approach can obviate the need for brain biopsy.
Main Methods:
- Retrospective analysis of MRI scans from 13 patients with solitary hemispheric demyelination.
- Evaluation of lesion morphology, size, location, and mass effect on MRI.
- Correlation of MRI findings with clinical data, including evoked potentials, electrophysiological studies, and cerebrospinal fluid (CSF) analysis.
Main Results:
- MRI lesions in solitary-ADEM were heterogeneously hyperintense on long TR/TE sequences and heterogeneously hypointense on short TR/TE sequences.
- A definitive diagnosis was achieved in 12 out of 13 patients using combined MRI and clinical data.
- One patient presented with tumor-like features, posing a diagnostic challenge.
Conclusions:
- Specific MRI characteristics, when combined with clinical assessments, are valuable for diagnosing solitary-ADEM.
- This integrated diagnostic approach enhances diagnostic accuracy and can help avoid unnecessary biopsies.
- Accurate diagnosis of solitary-ADEM is crucial for appropriate patient management.