Uric acid levels in sera from patients with multiple sclerosis.

The levels of uric acid (UA), a natural peroxynitrite scavenger, were measured in sera from 240 patients with multiple sclerosis (MS) and 104 sex- and age-matched control patients with other neurological diseases (OND). The mean serum UA concentration was lower in the MS than in the OND group, but the difference did not reach the level of statistical significance (P = 0.068). However, the mean serum UA level from patients with active MS (202.6 + 67.1 mumol/l) was significantly lower than that in inactive MS patients (226.5 + 78.6 mumol/l; P = 0.046) and OND controls (P = 0.007). We found a significant inverse correlation of serum UA concentration with female gender (P = 0.0001), disease activity (P = 0.012) and duration (P = 0.017), and a trend towards an inverse correlation with disability as assessed by EDSS score, which did not reach statistical significance (P = 0.067). Finally, multivariate linear regression analyses showed that UA concentration was independently correlated with gender (P = 0.0001), disease activity (P = 0.014) and duration of the disease (P = 0.043) in MS patients. These findings suggest that serum UA might serve as a possible marker of disease activity in MS. They also provide support to the potential beneficial therapeutic effect of radical-scavenging substances in MS.

Seizures in multiple sclerosis.

PURPOSE: In patients with multiple sclerosis (MS), epileptic seizures occur more frequently than in the general population. The aim of this study was to analyze clinical characteristics of epilepsy in patients with MS, potential correlation between the semiology of seizures, EEG and magnetic resonance imaging (MRI) findings in these patients, as well as to examine the response to anticonvulsant therapy. METHODS: In a series of 268 consecutive patients with definite MS hospitalized at the Institute of Neurology, Belgrade, we identified 20 (7.5%) patients with seizures or epilepsy. All patients with seizures or epilepsy were submitted to standard EEG and brain MRI with gadopentetate dimeglumine. RESULTS: In four patients, epilepsy occurred 1-5 years before other clinical manifestations of MS. Eight patients had seizures only during MS relapses (provoked seizures). In two of them, seizures were the only manifestations of relapse. In 12 patients, seizures occurred regardless of the phase of MS (chronic epilepsy). In the majority of patients, seizures were partial with secondary generalization. Five patients experienced episodes of status epilepticus, and they all had dementia. Abnormal EEG pattern was found in 11 patients. Brain MRI disclosed cortical-subcortical lesions in nine patients and focal cortical atrophy in one, whereas in the remaining patients, findings were inconclusive. Probable EEG-MRI-seizure type correlation existed in 10 patients. CONCLUSIONS: Our data suggest that epilepsy may represent an initial symptom of MS and a single clinical manifestation of a relapse, and further support the assumption of the existing correlation between the presence of cortical-subcortical lesions and epileptic seizures or epilepsy in patients with MS.

[Patterns of cerebral blood flow reactivity in adenosine stress-test in patients with carotid stenosis evaluated with MRI and emission tomography with 99m Tc-HMPAO]. / Otsenka reaktivnosti krovotoka golovnogo mozga s pomoshch'iu adenozinovoi proby u patsientov so stenozom sonnykh arterii, po dannym MRT i émissionnoi tomografii s 99m Tc-GMPAO.

In this study we evaluated the adenosine stress-test combined with 99mTc-HMPAO SPECT as a possible tool for evaluation of brain perfusion reserve in patients with various degrees of cortical neurologic damage due to internal carotid artery stenosis. The investigation comprised 37 patients with atherosclerotic carotid disease, in everybody of whom the stenosis was detected by echo-Doppler study of carotids and later in 28 verified also using invasive intraarterial digital subtractive angiography. In everybody the 99mTc-HMPAO SPECT study was performed twice: at rest and during stress-test with intravenous injection of adenosine with the patient in the supine position. It was gathered three groups of patients with different kinds of cerebral blood flow reactivity in adenosine stress-test. Henceforth, we conclude that, first, the 99mTc-HMPAO SPECT adenosin stress challenge of cerebral blood flow is a reliable functional test for every group of patients with extensive atherosclerosis and can be used for detection of patients with exhausted or decreased cerebral perfusion reserve in whom the risk of future cerebral vascular ischaemic events is elevated.

A 44-month clinical-brain MRI follow-up in a patient with B12 deficiency.

We report a 51-year-old woman with vitamin B12 deficiency who presented with slight megaloblastic anemia and severe neurologic deficits associated with multiple focal and confluent T2-weighted white matter hyperintensities on brain MRI. Forty-four months after initiation of hydroxocobalamin therapy, there was clinical improvement and striking reduction in the MRI abnormalities. B12 deficiency should be considered in the differential diagnosis of neurologic disorders associated with multiple areas of white matter hyperintensities on T2-weighted brain MRI.

[Sensitivity of criteria for MRI interpretation in patients with multiple sclerosis]. / Senzitivnost kriterijuma za interpretaciju nalaza magnetine rezonancije kod bolesnika od multiple skleroze.

UNLABELLED: Magnetic resonance imaging (MRI) has become the preferred imaging technique in multiple sclerosis (MS). Areas of increased signal (AIS) are detected on T2-weighted (T2W) pulse sequencies in 70-100% of patients with clinically definite MS. However, AIS similar to those seen in MS have also been described in healthy elderly subjects and patients with various neurological disorders including several vasculitises, migraine, and trauma. The aim of this study was to test and compare the sensitivity of different currently used MRI criteria for the diagnosis of MS. METHOD: The study comprised 49 patients wiht clinically definite MS diagnosed according to McAlpine's criteria. Cranial MRI was performed on a 1.5 T Magnetom with spin-echo pulse technique defined by relaxation times: T1W, T2W and proton density. Gadolinium-DTPA was not administred. We interpreted only spin-echo T2W images because they are the most sensitive for MS. The presence, number, size and location of AIS were recorded for all scans. We calculated the sensitivity for the four different sets of criteria (Paty's A and B criteria, Fazekas' criteria and Barkhof's criteria). The presence of four AIS greater than 3 mm was designated as Paty's A criteria, and presence of three AIS, one periventricular, greater than 3 mm was designated as Paty's B criteria. Fazekas' criteria require the presence of at last three AIS and two of the following three features: abutting body of lateral ventricles, infratentorial lesion location, and size = 6 mm. Barkhof's criteria were considered fulfilled if at least eight AIS were present, one infratentorial. RESULTS AND DISCUSSION: Brain MRI revealed normal finding in four (8%) of 49 studied patients with clinically definite MS. Number, size and location of AIS detected in the remaining patients is presented in Table. Characteristic patterns of MRI lesions on T2W images fulfilling different sets of criteria for the diagnosis of MS are presented in Figures 1-3. Using Paty's B criteria, sensitivity of MRI in patients with clinically definite MS was the highest, reaching 92%. Applying Paty's A criteria sensitivity slightly decreased to 88%. Using Fazeka's and Barkhof's criteria led to a further, significant decrease in sensitivity (71% and 57%, respectively; p = 0.045). In 1993, Offenbacher et al. have reviewed 1500 consecutive brain MRI scans for the presence, number, size and location of AIS, and calculated the sensitivity and specificity of Paty's and Fazekas' criteria with respect to clinical evidence for MS. In this study, similar to our results, using Paty's criteria resulted in higher sensitivity (87% for Paty A and 90% for Paty B) than Fazekas' criteria which led to decrease in sensitivity (81%). However, when Fazekas' criteria were used, decrease in sensitivity was associated with highly significant improvement of specificity. In conclusion, according to our and previously published results, Paty's criteria based on the presence of three AIS, one periventricular, or on the presence of four AIS, greater than 3 mm, are the most sensitive for MRI interpretation in MS. Other criteria (greater number of AIS, greater AIS diameter, infratentorial location and gadolinium enhancement) should be used, in order to improve the specificity, only to the MRIs of elderly patients (> 50 years) with suspected MS or patients suspected of MS in whom alternative explanations seem equally similar.

[Mitochondrial encephalomyoneuropathy. Case report]. / Mitohondrijska encefalomioneuropatija (prikaz bolesnika).

Mitochondrial myopathies and encephalomyopathies constitute a group of degenerative disorders characterized by a striking degree of clinical, biochemical and genetic heterogenity. We present a case of a 42-year old woman with clinical, electrophysiological and laboratory features of a mitochondrial encephalomyoneuropathy. A muscle biopsy specimen showed ragged-red fibres. Signs of demyelination and remyelination of a few fibers were observed in a sural nerve biopsy specimen. MR imaging revealed symmetrical multifocal white matter lesions predominantly in the parieto-occipital region. We stress the benefitial therapeutic effect of CoQ since it resulted in marked alleviation of some signs of the disease.

[Magnetic resonance in the diagnosis of pathologic changes in the infundibulum of the hypophyseal gland]. / Magnetna rezonancija u dijagnostici patoloskih promena peteljke hipofizne zlezde.

Magnetic resonance imaging (MRI) is a new, non-invasive neuroradiological diagnostic procedure for direct multiplanar visualization of the anatomic structures of pituitary gland infundibulum. MRI is extremely sensitive in demonstrating pathological changes of infundibulum, and is a method of choice for diagnosis of its breakage. Forty-eight patients with pituitary hypofunction have been examined on MRI to demonstrate empty sellae and/or breakage of infundibulum. Pathological changes of infundibulum were found in 11 patients, five of which had breakage (congenital or traumatic). Optimal MRI protocol, with application of paramagnetic contrast agent, for examination of pituitary gland has been established.

[von Recklinghausen's neurofibromatosis]. / Neurofibromatosis von Recklinghausen.

We present a case of unusual clinical picture of the well defined Morbus Von Recklinghausen. In a 35-year-old male patient, after an uncontrolled rapid movement of the neck, the disease was suddenly manifested with spastic quadriparesis. Three years later the clinical picture showed spastic quadriplegia. Antalgic torticollis confirmed by X-ray of the neck clearly showed vertebral subluxation at the level of C3-C4. However, additional magnetic resonance imaging revealed large extradural tumorous formation at the level of C1-C2, and two small oval tumours in the splenium of the corpus callosum as well as in the left lateral ventricle. "Café au lait" spots, "molluscum fibrosum" and few subcutaneous fibromas appeared as skin changes which explained the possible nature of the registered intracranial and intraspinal tumours. Neurosurgery has been performed at the spinal level with good results; it confirmed the diagnosis of Von Recklinghausen's Neurofibromatosis.