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Pearls & Oy-sters: Radiologic Lag in Pediatric-Onset Multiple Sclerosis.

Amytice Mirchi1, Arastoo Vossough2, Grant T Liu3

  • 1Division of Child Neurology, Children's Hospital of Philadelphia, University of Pennsylvania.

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Summary

Radiologic lag, where symptoms appear before MRI lesions, can occur in pediatric multiple sclerosis. Early diagnosis requires considering follow-up imaging when initial scans are negative despite clinical signs of demyelination.

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Area of Science:

  • Neurology
  • Radiology
  • Immunology

Background:

  • Radiologic lag is crucial in diagnosing demyelinating diseases, presenting as clinical symptoms without visible MRI lesions.
  • Pediatric-onset multiple sclerosis (MS) and myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) are key demyelinating conditions where this phenomenon is observed.

Purpose of the Study:

  • To highlight the occurrence of radiologic lag in pediatric-onset MS.
  • To emphasize the importance of follow-up imaging in cases of suspected demyelination with initial negative MRI findings.

Main Methods:

  • Case report of a 16-year-old girl with bilateral internuclear ophthalmoplegia (INO).
  • Initial high-resolution 3T MRI of the brainstem showed no abnormality.
  • Repeat MRI two months later revealed a lesion in the paramedian midbrain tegmentum.

Main Results:

  • Initial MRI failed to detect a lesion despite the patient's bilateral INO.
  • A subsequent MRI confirmed a brainstem lesion correlating with clinical symptoms.
  • This illustrates radiologic lag in a pediatric MS case.

Conclusions:

  • The absence of MRI lesions does not rule out demyelination, especially in acute INO.
  • Short-interval follow-up MRI is recommended for patients with suspected demyelination and negative initial imaging.
  • Timely diagnosis through follow-up imaging is vital for appropriate management of pediatric demyelinating diseases.