ABSTRACT
OBJECTIVES: Multiple sclerosis (MS) is the most common chronic disabling disease of the central nervous system (CNS) in young adults. It is characterized by the presence of multiple demyelinating inflammatory lesions disseminated in the CNS. Pseudotumoral lesions (PL) are rarely observed in patients with MS. METHODS: These atypical lesions can pose a diagnostic problem, especially when they are present at disease onset. RESULTS: Most MS patients with PLs only have a single episode throughout their disease course, which reflects its low tendency of recurrence. CONCLUSIONS: We report the rare case of a 34-year-old MS patient who suffered from recurrent pseudotumoral episodes during follow-up.
Subject(s)
Brain/diagnostic imaging , Multiple Sclerosis, Relapsing-Remitting/diagnostic imaging , Adult , Brain Neoplasms/diagnostic imaging , Diagnosis, Differential , Female , Humans , Magnetic Resonance Imaging , Multiple Sclerosis, Relapsing-Remitting/drug therapyABSTRACT
RATIONALE: No neuroprotective or neurorestorative therapies have been approved for ischemic stroke. Bone marrow mononuclear cell intra-arterial transplantation improves recovery in experimental models of ischemic stroke. AIMS: This trial aims to test safety and efficacy of intra-arterial injection of autologous bone marrow mononuclear cell in ischemic stroke patients. DESIGN: Multicenter, prospective, phase II, randomized, controlled (non-treated group as control), assessor-blinded clinical trial. Seventy-six stroke patients will be enrolled. Patients fulfilling clinical and radiological criteria (e.g. age between 18 and 80 years, middle cerebral artery ischemic stroke with a National Institutes of Health Stroke Scale score of 6-20 within one- to seven-days from stroke onset and no lacunar stroke) will be randomized to intervention or control group (1 : 1). Bone marrow harvest and intra-arterial injection of autologous bone marrow mononuclear cell will be done in the intervention group with two different doses (2 × 10(6) /kg or 5 × 10(6) /kg in 1 : 1 proportion). Patients will be stratified at randomization by National Institutes of Health Stroke Scale score. Patients will be followed up for two-years. STUDY OUTCOMES: The primary outcome is the proportion of patients with modified Rankin Scale scores of 0-2 at 180 days. Secondary outcomes include National Institutes of Health Stroke Scale and Barthel scores at six-months, infarct volume, mortality, and seizures. DISCUSSION: This is the first trial to explore efficacy of different doses of intra-arterial bone marrow mononuclear cell in moderate-to-severe acute ischemic stroke patients. The trial is registered as NCT02178657.
