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#immunology #biology #autoimmunedisease # Video Rating: / 5
This is the first lecture in a case based review of imaging of the brain and spine for autoimmune and inflammatory conditions. We will cover the MRI findings of some of the common conditions and some potential pitfalls and mimics.
This first lecture covers demyelinating disease, with the most common being multiple sclerosis (or MS), neuromyelitis optica (NMO), and acute disseminated encephalomyelitis (ADEM). These are all demyelinating/autoimmune conditions in which the brain loses its normal myelination.
2:52 Multiple sclerosis
MS is the most common demyelinating disease, affecting women more than men, with 2 age distribution peaks in younger and middle age women. MS commonly presents with optic nerve or visual symptoms, affects the brain more commonly than the spine, and can result in short segment spine lesions.
5:27 Neuromyelitis optica
Neuromyelitis optica, or NMO, is an autoimmune disease characterized by predominantly optic nerve and spine lesions. It is often associated with an antibody to aquaporin 4.
8:53 Acute disseminated encephalomyelitis (ADEM)
ADEM is an acute fulminant demyelinating syndrome characterized by acute onset and often many supratentorial lesions. The majority of patients recover, although some may have residual symptoms and it can even progress to death.
11:48 Acute hemorrhagic encephalomyelitis (AHEM)
AHEM is a closely related variant of ADEM which is associated with hemorrhage.
13:24 Susac syndrome
Susac syndrome is a small vessel vasculitis with small vessel infarcts, most commonly in the retina, cochlea, and periventricular white matter and corpus callosum. It can frequently mimic demyelinating disease because the distribution of lesions is similar.
14:44 Summary and Conclusion
The level of this lecture is appropriate for radiology residents, radiology fellows, and trainees in other specialties, such as neurology, who have an interest in neuroradiology or may see patients with CNS demyelinating or inflammatory conditions.
Check out this video and additional content on http://www.learnneuroradiology.com
#neuroradiology #radiology #demyelination
What is multiple sclerosis? Multiple sclerosis is a chronic and progressive neurological disease that results in neuronal cell death, which can lead to a variety of symptoms. Find our full video library only on Osmosis: http://osms.it/more.
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This is a brief video on non-hereditary demyleinating disorders.
I created this presentation with Google Slides.
Image were created or taken from Wikimedia Commons
I created this video with the YouTube Video Editor.
ADDITIONAL TAGS:
Acquired demyelinating diseases
Non-hereditary diseases in which normally-formed myelin degenerates as a result of insult on myelin or oligodendrocytes with preservation of the axons
Multiple sclerosis
Acute disseminated encephalo-
myelitis
Progressive multifocal leukoenceph-
alopathy
Leukoenceph-
alopathy associated
with AIDS
Central
pontine myelinolysis
By BruceBlaus – Own work, CC BY-SA 4.0, https://commons.wikimedia.org/w/index.php?curid=44926477
Multiple sclerosis (MS)
Most common chronic CNS disorder in young adults (up to 1/1000)
Perivascular inflammation
Shows both acute and chronic lesions (polyphasic)
Acute: loss of oligodendrocytes; reactive astrocytes/macrophages
Chronic: fibrous astrocyte gliosis
Diagnosed with MRI and oligoclonal IgG bands in CSF (but not in serum)
RIGHT: abundant neutrophils and macrophages infiltrate where myelin is missing (top-left of image)
Distinct lesion edge
Multiple sclerosis
Acute disseminated encephalo-
myelitis
Progressive multifocal leukoenceph-
alopathy
Leukoenceph-
alopathy associated
with AIDS
Central
pontine myelinolysis
By Marvin 101 – Own work, CC BY-SA 3.0, https://commons.wikimedia.org/w/index.php?curid=2846763
Acute disseminated encephalomyelitis (ADEM)
Resembles MS (sometimes called borderline form of MS)
Thought to follow viral infection (flu, MMR, herpes)
Perivenous inflammation
Loss of white matter to the vessels, histo shows macrophages
Monophasic lesions in white matter
Multiple sclerosis
Acute disseminated encephalo-
myelitis
Progressive multifocal leukoenceph-
alopathy
Leukoenceph-
alopathy associated
with AIDS
Central
pontine myelinolysis
Progressive multifocal leukoencephalopathy (PML)
Caused by the papovavirus JC virus
Most people have positive serology for JC (infected), with virus kept under control
Complication for immunocompromised patients (AIDS)
Early stage: multiple demyelination foci in white matter
Late stage: growing necrotic lesion involves cortex
Histo:
Macrophages engulfing myelin debris; not many other WBCs bc immunocompromised
Large, bizarre, transformed astrocytes
Enlarged oligodendroglial nuclei
Multiple sclerosis
Acute disseminated encephalo-
myelitis
Progressive multifocal leukoenceph-
alopathy
Leukoenceph-
alopathy associated
with AIDS
Central
pontine myelinolysis
Leukoencephalopathy associated with AIDS
Perivascular giant cells (multinucleated, with HIV antigens)
Release toxic cytokines that play role in pathogenesis
Causes AIDS dementia
Pallor of cerebral white matter (myelin degeneration not seen on histo)
Normal CT on left, AIDS brain on right
Multiple sclerosis
Acute disseminated encephalo-
myelitis
Progressive multifocal leukoenceph-
alopathy
Leukoenceph-
alopathy associated with AIDS
Central
pontine myelinolysis
LEFT:
By Afiller (talk) (Uploads) – Own work, CC BY-SA 3.0, https://en.wikipedia.org/w/index.php?curid=23542660
RIGHT:
Public domain (government work)
Central pontine myelinolysis
Pathogenesis
Patients have chronic, severe hyponatremia (low Na)
Intracellular adaptations (cells pump out other osmoles) to compensate
Patients treated with saline to increase serum tonicity
Cells can’t decompensate fast enough, causes shearing of the myelin cells
Predominantly iatrogenic
Demyelination is worse at base of pons (sometimes lateral geniculate bodies and internal/external capsules → osmotic myelinolysis)
Multiple sclerosis
Acute disseminated encephalo-
myelitis
Progressive multifocal leukoenceph-
alopathy
Leukoenceph-
alopathy associated
with AIDS
Central
pontine myelinolysis
Pontine perivascular fibers hypointense to the rest of the pons
By Jto410 – clinical work as a radiologist, CC BY-SA 3.0, https://commons.wikimedia.org/w/index.php?curid=25606029 Video Rating: / 5
