Oligoclonal bands in the cerebrospinal fluid and increased brain atrophy in early stages of relapsing-remitting multiple sclerosis.

OBJECTIVE: To determine if the presence of oligoclonal bands (OB) at early stages of multiple sclerosis was associated with higher brain atrophy, when compared with patients without OB. METHODS: Relapsing-remitting multiple sclerosis (RRMS) patients with less than two years of disease onset and OB detection in cerebrospinal fluid (CSF) were included. SIENAX was used for total brain volume (TBV), gray matter volume (GMV), and white matter volume (WMV). RESULTS: Forty patients were included, 29 had positive IgG-OB. No differences were found between positive and negative patients in gender, expanded disability status scale (EDSS), treatment received, and T2/T1 lesion load. TBV in positive IgG-OB patients was 1.5 mm³ x 10(6) compared with 1.64 mm³ x 10(6) in the negative ones (p=0.02). GMV was 0.51 mm³ x 10(6) in positive IgG-OB compared with 0.62 mm³ x 10(6) in negative ones (p=0.002). No differences in WMV (p=0.09) were seen. CONCLUSIONS: IgG-OB in the CSF was related to neurodegeneration magnetic resonance (MR) markers in early RRMS.

Oligoclonal bands in the cerebrospinal fluid and increased brain atrophy in early stages of relapsing-remitting multiple sclerosis / Bandas oligoclonales en líquido cefalorraquídeo y incremento de la atrofia cerebral en estadios tempranos de pacientes con esclerosis múltiple forma recaída-remisión

OBJECTIVE: To determine if the presence of oligoclonal bands (OB) at early stages of multiple sclerosis was associated with higher brain atrophy, when compared with patients without OB. METHODS: Relapsing-remitting multiple sclerosis (RRMS) patients with less than two years of disease onset and OB detection in cerebrospinal fluid (CSF) were included. SIENAX was used for total brain volume (TBV), gray matter volume (GMV), and white matter volume (WMV). RESULTS: Forty patients were included, 29 had positive IgG-OB. No differences were found between positive and negative patients in gender, expanded disability status scale (EDSS), treatment received, and T2/T1 lesion load. TBV in positive IgG-OB patients was 1.5 mm³ x 10(6) compared with 1.64 mm³ x 10(6) in the negative ones (p=0.02). GMV was 0.51 mm³ x 10(6) in positive IgG-OB compared with 0.62 mm³ x 10(6) in negative ones (p=0.002). No differences in WMV (p=0.09) were seen. CONCLUSIONS: IgG-OB in the CSF was related to neurodegeneration magnetic resonance (MR) markers in early RRMS.

OBJETIVO: Evaluar si la presencia de bandas oligoclonales (BO) en líquido cefalorraquídeo (LCR) de pacientes con esclerosis múltiple recaídaremisión (EMRR) se asociaba con mayor atrofia cerebral al inicio de la enfermedad. MÉTODOS: Pacientes con EMRR con menos que dos años del inicio de la enfermedad y en quiénes se realizó la búsqueda de IgG-BO en LCR fueron incluidos. SIENAX fue usado para la medición del volumen cerebral total (VCT), volumen de substancia gris (VSG) y volumen de sustancia blanca (VSB). RESULTADOS: Cuarenta pacientes fueron incluidos, 29 tenían IgG-BO positivo. No fueron encontradas diferencias entre pacientes positivos y negativos en: género, expanded disability status scale (EDSS), tratamiento recibido y carga lesional en resonancia magnética. El VCT en pacientes IgG-BO positivos fue de 1,5 mm³ x 10(6) versus 1,64 mm³ x 10(6) en BO negativo (p=0,02). El VSG fue 0,51 mm³ x 10(6) BO positivo versus 0,62 mm³ x 10(6) BO negativo (p=0,002). No fueron encontradas diferencias en VSB (p=0,09). CONCLUSIONES: La presencia de IgG-BO en el LCR se asoció con signos de neurodegeneración temprana en este estudio.

HAM/TSP: association between white matter lesions on magnetic resonance imaging, clinical and cerebrospinal fluid findings.

OBJECTIVE: To investigate the association between clinical data, white matter lesions and inflammatory cerebrospinal fluid (CSF) findings in HTLV-1 associated myelopathy/tropical spastic paraparesis (HAM/TSP). METHOD: We studied brain and cervical spinal cord on magnetic resonance imaging (MRI) and CSF examinations of 28 Brazilian HAM/TSP patients. RESULTS: The majority of patients had severe neurological incapacity with EDSS median of 6.5 (3-8). The brain MRI showed white matter lesions (75%) and atrophy (14%). The preferential brain location was periventricular. Cervical demyelination lesions occurred in 11% of the cases, and cervical atrophy in 3.5%. One patient had enhancement lesions on T1 cervical spinal cord MRI. Cases with spinal cord lesions had signs of acute CSF inflammation. The brain white matter lesions predominated in the patients with higher age. CONCLUSION: Our data suggest that an active inflammatory process is associated with the cervical spinal cord lesions in HAM/TSP. The brain abnormalities are not related to the clinical picture of HAM/TSP.

HAM/TSP: association between white matter lesions on magnetic resonance imaging, clinical and cerebrospinal fluid findings / HAM/TSP: associação entre lesões de substância branca à ressonância magnética, achados clínicos e do líquido cefalorraquidiano

OBJECTIVE: To investigate the association between clinical data, white matter lesions and inflammatory cerebrospinal fluid (CSF) findings in HTLV-1 associated myelopathy/tropical spastic paraparesis (HAM/TSP). METHOD: We studied brain and cervical spinal cord on magnetic resonance imaging (MRI) and CSF examinations of 28 Brazilian HAM/TSP patients. RESULTS: The majority of patients had severe neurological incapacity with EDSS median of 6.5 (3-8). The brain MRI showed white matter lesions (75%) and atrophy (14%). The preferential brain location was periventricular. Cervical demyelination lesions occurred in 11% of the cases, and cervical atrophy in 3.5%. One patient had enhancement lesions on T1 cervical spinal cord MRI. Cases with spinal cord lesions had signs of acute CSF inflammation. The brain white matter lesions predominated in the patients with higher age. CONCLUSION: Our data suggest that an active inflammatory process is associated with the cervical spinal cord lesions in HAM/TSP. The brain abnormalities are not related to the clinical picture of HAM/TSP.

OBJETIVO: Analisar a associação entre aspectos clínicos, lesões de substância branca e reação inflamatória aguda no líquido cefalorraquidiano (LCR) na mielopatia associa ao HTLV-1 (HAM/TSP). MÉTODO: Foram estudadas ressonâncias magnéticas (RM) do encéfalo/medula espinhal cervical e exame do LCR de 28 pacientes com HAM/TSP. RESULTADOS: A maioria dos pacientes apresentava grave incapacidade neurológica, com EDSS 6,5 (3-8). A RM revelou lesões da substância branca (75%) com predominância periventricular e atrofia cortical (14%). Lesões desmielinizantes cervicais ocorreram em 11% dos casos e atrofia em 3,5%. Um paciente apresentou lesão cervical na T1 com captação de contraste. Sinais de inflamação aguda no LCR ocorreram em situações de lesão da medula espinhal cervical. As alterações de substância branca do encéfalo predominaram nos indivíduos com maior faixa etária. CONCLUSÃO: Nossos achados sugerem que processo inflamatório com atividade clínica na HAM/TSP está associado a lesões da medula espinhal cervical. As anormalidades da substância branca encefálicas não são relacionadas ao quadro clínico de HAM/TSP.

Intrathecal immunoglobulin G synthesis and brain injury by quantitative MRI in multiple sclerosis.

OBJECTIVES: It was the aim of this study to evaluate if the quantitative intrathecal immunoglobulin G (IgG) synthesis correlates with the brain atrophy and the total lesion volume (TLV) in brain magnetic resonance imaging (MRI) of multiple sclerosis (MS) patients. METHODS: A total of 50 patients with relapsing-remitting MS were included in this study. MRIs were performed and cerebrospinal fluid samples were collected during the diagnostic determination when patients were in remission without treatment. RESULTS: At study baseline, IgG index values were elevated in 36 patients (72%), and oligoclonal IgG bands were positive in 42 of 50 patients (84%). Brain MRI was abnormal in 94% of patients, and, compared with healthy controls, brain atrophy was observed in MS patients. A positive correlation among IgG index, cerebrospinal fluid leukocyte count and TLV was observed; the Expanded Disability Status Scale correlated positively with TLV and the number of lesions, although a significant relationship between disability and brain atrophy was not demonstrated. CONCLUSIONS: Although new parameters will be necessary in longitudinal studies to characterize the axonal injury in various stages of the disease, the data suggest that the high intrathecal IgG synthesis may predict a greater brain lesion burden.

Atrofia cerebral em pacientes HIV-1 positivos / Atrophy in asymptomatic HIV-1 positive patients

Este estudo teve como objetivo a avaliação da atrofia cerebral em pacientes HIV-1 positivos assintomáticos ou com AIDS. Foram estudados 38 pacientes com o Vírus da Imunodeficiência Humana tipo (HIV-1) positivos, divididos em dois grupos de acordo com a contagem de células T CD4+: Grupo 1( T CD4+>200) com 20 pacientes e Grupo 2 (T CD4+<_200) com 18 pacientes. Os pacientes foram comparados com o Grupo Controle (Grupo 3) composto por 7 pessoas voluntárias e HIV-1 negativas. Os pacientes e voluntários foram avaliados em uma única ocasião, quando foram realizados exames clínico, neurológico, hematológico, liquorológicos e tomografia axial de crânio. Amostras de líquido cefalorraquidiano (LCR) e sangue foram obtidos para avaliação dos níveis de infecção pelo HIV-1(carga viral), do...

Cerebellar atrophy related to chronic exposure to toluene. Case report.

A 31-year-old woman presented slowly progressing ataxia and neurasthenic symptoms after 14-year occupational exposure to low concentration toluene vapour. Examination disclosed only cerebellar signs. Cognitive functions were normal except moderate visuo-spatial and constructive deficit. CT imaging showed severe pancerebellar atrophy without pathological signs in other brain structures. Two years after she was removed from workplace, CT imaging and ataxia showed no worsening, while visuo-constructive function improved. The authors warn against possible neurotoxic risk associated with this kind of exposure.

Cerebellar atrophy related to chronic exposure to toluene: case report

Uma mulher de 31 anos desenvolveu síndrome cerebelar e neurastênica, de evoluçäo lentamente progressiva, após 14 anos de exposiçäo ocupacional a vapores de toluenos em baixas concentraçöes. Os únicos achados do exame neurológico e neuropsicológico foram sinais cerebelares (severos) déficit visuo-espacial e práxico-construcional (moderado). A neuroimagem tomográfica mostrava acentuada atrofía e a neuroimagem (TC) estavam inalteradas, enquanto a funçäo visuo-construcional havia parcialmente melhorado. Os autores chamam a atençäo para o possível risco neurotóxico relacionado a esse tipo de exposiçäo, numa tentativa de prevençäo de casos semelhantes