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Magnetic resonance imaging in asymptomatic disseminated vasculomyelinopathy
1Department of Neurology, Harvard Medical School, Beth Israel Hospital, Boston, MA 02215.
Abstract:
Two cases of disseminated vasculomyelinopathy (one of acute disseminated encephalomyelitis (ADEM), the other of acute transverse myelitis), are reported because of the persistence, 3 years and 5 months respectively, of abnormalities of magnetic resonance imaging (MRI). These abnormalities remained although in the first case the disease had been essentially asymptomatic from the onset except for one seizure, the patient remaining neurologically intact, whereas in the second case, the patient had made a complete recovery from very serious neurologic dysfunction. The first case illustrates the fact that ADEM may rarely occur without any symptoms, even in the presence of severe imaging abnormalities in both CT and MRI. Neither the persistence of a blood-brain barrier permeability alteration nor gliosis can satisfactorily explain the MRI changes, and thus the pathological significance of areas of increased signal intensity in MRI remains poorly understood and a matter of uncertainty. This report emphasizes the futility of attempting to correlate any kind of clinical observation, laboratory parameter, or effect of therapeutic regimens with changes, or lack thereof, in the MRI in multiple sclerosis and disseminated vasculomyelinopathy.
Insights
Disseminated vasculomyelinopathy can cause persistent MRI abnormalities even in asymptomatic patients or those with full recovery. The exact cause of these persistent imaging changes remains unclear.
Area of Science:
- Neuroimmunology
- Neuroradiology
Background:
- Disseminated vasculomyelinopathy encompasses conditions like acute disseminated encephalomyelitis (ADEM) and acute transverse myelitis.
- Magnetic resonance imaging (MRI) is crucial for diagnosing and monitoring these neurological disorders.
Observation:
- Two cases of disseminated vasculomyelinopathy presented with persistent MRI abnormalities for over three years.
- One patient with ADEM was largely asymptomatic, while the other fully recovered from severe neurological deficits.
Findings:
- Persistent MRI abnormalities were observed despite varying clinical presentations and recovery statuses.
- The underlying pathology explaining persistent T2-hyperintensities on MRI, such as blood-brain barrier permeability or gliosis, remains uncertain.
- ADEM can manifest with significant imaging abnormalities without overt clinical symptoms.
Implications:
- The study highlights the disconnect between clinical recovery and persistent imaging findings in disseminated vasculomyelinopathy.
- It questions the direct correlation between clinical status, therapeutic responses, and MRI changes in these conditions.
- Further research is needed to elucidate the pathological significance of persistent MRI signal abnormalities.