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Brainstem lesions in clinically isolated syndromes.

M Tintore1, A Rovira, G Arrambide

  • 1Unitat de Neuroimmunologia Clinica (UNIC), Edif. Escola d'infermeria planta 2, Hospital Universitari Vall d'Hebron, Pg Vall d'Hebron 119-129, 08035 Barcelona, Spain. mtintore@vhebron.net

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Summary

Baseline infratentorial lesions in clinically isolated syndromes (CIS) predict increased risk of future attacks and disability. Brainstem lesions, in particular, are associated with a poorer long-term prognosis, highlighting their importance in patient management.

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Area of Science:

  • Neurology
  • Neuroimaging
  • Clinical Prognostics

Background:

  • Baseline lesion load in clinically isolated syndromes (CIS) is a known predictor of disease activity and disability.
  • The specific prognostic value of infratentorial lesions in CIS requires further elucidation.

Purpose of the Study:

  • To investigate the long-term prognostic significance of baseline infratentorial lesions in patients with CIS.
  • To determine if lesion location (infratentorial) and number impact conversion to multiple sclerosis and disability progression.

Main Methods:

  • A prospective cohort study included 246 patients diagnosed with CIS.
  • Brain MRI scans were performed within 3 months of CIS onset to assess lesion load and location.
  • Patients were followed for a median of 7.7 years to track time to a second clinical attack and Expanded Disability Status Scale (EDSS) 3.0.

Main Results:

  • Patients with infratentorial lesions exhibited a significantly higher risk of conversion to multiple sclerosis (71.4% vs 29.6%) and disability (32.5% vs 12.4%).
  • Presence of brainstem lesions was strongly associated with increased risk of both conversion (HR 2.9) and disability (HR 2.5).
  • Infratentorial lesions conferred a markedly higher risk of conversion (HR 22.3) and disability (HR 3.2) in patients with 9 or more baseline lesions.

Conclusions:

  • Baseline infratentorial lesions are significant predictors of long-term disability in CIS patients.
  • Brainstem lesions appear to be a more critical factor than cerebellar lesions in determining a poor prognosis for CIS.
  • Identifying infratentorial lesions, especially in patients with high lesion burden, is crucial for risk stratification and management.