Asymptomatic spinal cord lesions in clinically isolated optic nerve, brain stem, and spinal cord syndromes suggestive of demyelination

摘要

OBJECTIVES—Conventional T2 weighted MRI studieshave highlighted the fact that the presence of clinically silent brainlesions increases the risk of developing clinically definite multiplesclerosis after an isolated syndrome of the optic nerve, brain stem, or spinal cord. The objectives of the present study are: (1) to show whether or not these patients also have asymptomatic abnormalities ofthe spinal cord, and (2) to recruit a new cohort of such patients usinghigh resolution MRI of both brain and spinal cord.
METHODS—The brain was imaged in the axial planewith 3 mm thick contiguous slices using a proton density and T2weighted fast spin echo (FSE) sequence; a T1 weighted sequence afterthe injection of gadolinium-DTPA; and a fast fluid attenuated inversionrecovery (fFLAIR) sequence. The spinal cord was imaged in the sagittal plane with 3 mm thick slices using a T2 weighted FSE and a T1 weightedgadolinium enhanced sequence.
RESULTS—Thirty three patients, meanage 31 (16-46) were recruited. There were 14 men and 19 women. BrainMRI was abnormal in 22 (67%); no patient was seen with abnormalitieson only one or other sequence. Six patients (18%)displayed one or more gadolinium enhancing lesions on brain MRI. In thespinal cord, nine (27%) patients displayed one or more clinicallysilent lesions on FSE. Two patients showed one and two gadoliniumenhancing lesions in the spinal cord respectively.
CONCLUSION—This high incidence of spinal cordlesions emphasises that asymptomatic demyelinating lesions may alsoinvolve clinically eloquent pathways. Follow up studies are required todetermine their prognostic importance.