Acute demyelinating lesions with restricted diffusion in multiple sclerosis

Research output: Contribution to journalReview articlepeer-review

30 Scopus citations

Abstract

Background and objectives: It is widely accepted that typical acute demyelinating lesions in relapsingremitting multiple sclerosis (RRMS) exhibit vasogenic edema with increased diffusion, as demonstrated by an increased apparent diffusion coefficient on MRI. In contrast, acute ischemic lesions demonstrate cytotoxic edema with restricted diffusion. Recent reports have documented selected cases of acute demyelinating lesions exhibiting restricted diffusion (ADLRD) in MS. We aimed to assess the morphologies, distributions, signal characteristics and changes over time of nine ADLRD. An additional goal was to obtain clinical correlations and relate our findings to all previously published case reports describing ADLRD. Methods: A retrospective case series study was performed at two academic centers. MRI characteristics of nine ADLRD found in six RRMS patients were compared with typical active symptomatic contrast-enhancing lesions with increased or normal diffusion in control RRMS patients. Results: The average size of ADLRD was not significantly different from typical lesions. A periventricular location and faint signal on T2-weighted images were significantly more common for ADLRD compared with typical lesions. Two patients with ADLRD on initial MRI exhibited new ADLRD on their follow up scans. Conclusion: Our results and review of prior published cases suggest that ADLRD represent a new variant of MS lesion. The restricted diffusion that is a characteristic of ADLRD on MRI is a new challenge in the differential diagnosis of stroke in young adults. The pathogenesis of ADLRD remains to be understood.

Original languageEnglish (US)
Pages (from-to)1745-1753
Number of pages9
JournalMultiple Sclerosis Journal
Volume18
Issue number12
DOIs
StatePublished - Dec 2012

All Science Journal Classification (ASJC) codes

  • Neurology
  • Clinical Neurology

Keywords

  • brain edema
  • demyelinating diseases
  • diffusion magnetic resonance imaging
  • magnetic resonance imaging
  • multiple sclerosis
  • relapsing-remitting multiple sclerosis

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