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Focal cortical atrophy following transient meningeal enhancement in a progressive multiple sclerosis

Mickael Bonnan1, Paul Money2, Pauline Desblache2

  • 1Neurologie, Centre hospitalier de Pau, 4 Bd Hauterive, 64000, Pau, France. mickael_bonnan@yahoo.fr.

Neurological Sciences : Official Journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology
|September 30, 2020
PubMed

Insights

Chronic leptomeningeal enhancement (LME) in multiple sclerosis (MS) may resolve, yet still contribute to cortical atrophy. Advanced MRI techniques are crucial for detecting these subtle but significant inflammatory changes in secondary progressive MS.

Area of Science:

  • Neuroimaging
  • Neurology
  • Radiology

Background:

  • Chronic leptomeningeal enhancement (LME) on MRI is associated with inflammation and cortical atrophy in secondary progressive multiple sclerosis (SP MS).
  • Previous research suggests LME correlates with pathological findings of focal cortical inflammation and demyelination.

Purpose of the Study:

  • To investigate the potential for spontaneously remitting meningeal uptake in SP MS.
  • To evaluate the role of conventional MRI sequences versus T1-enhanced sequences in detecting meningeal lesions and their impact on cortical atrophy.

Main Methods:

  • Case report of a patient with SP MS experiencing spontaneously remitting meningeal uptake.
  • Utilized conventional 3-T MRI sequences (FLAIR, DIR) and T1-enhanced sequences.
  • Assessed cortical lesion visibility and quantified the rate of cortical atrophy in affected areas.

Main Results:

  • A case of spontaneously remitting meningeal uptake was observed in an SP MS patient.
  • No cortical lesions were visible on FLAIR or DIR sequences, despite higher cortical atrophy rates in the affected area.
  • T1-enhanced sequences highlighted inflammatory activity, suggesting LME's direct role in cortical atrophy.

Conclusions:

  • Conventional MRI may underestimate the burden of regressive meningeal lesions in SP MS.
  • Leptomeningeal enhancement might be an active driver of focal cortical atrophy and an early indicator of cortical lesions in SP MS.
  • T1-enhanced MRI is valuable for assessing inflammatory activity and the true impact of LME in SP MS.
Keywords:
Cortical atrophyLeptomeningeal contrast enhancementMultiple sclerosisRelapse

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