Preferential spinal central gray matter involvement in neuromyelitis optica

ObjectiveTo delineate the MRI features that distinguish neuromyelitis optica (NMO) from multiple sclerosis (MS).MethodsWe compared the distribution of the spinal cord lesions by analyzing 1) lesion area, 2) lesion density (by superimposing the lesions onto the standard sections of the cervical and thoracic cord with appropriate transparencies using computer software), and 3) T1-hypointensity in axial sections of MRI in NMO and MS.ResultsIn NMO, 60–70% of the cervical and thoracic cord MRI lesions occupied more than half of the cord area and mainly involved the central gray matter in the acute stage. In the chronic stage, half or more of the lesions were localized at the central gray matter region. The lesion superimposition analysis also revealed much higher densities in the central gray matter region than in the peripheral white matter regions. Two patients with NMO had T1-hypointense lesions in the central region. In contrast, over 80% of the lesions in MS were localized in the lateral and posterior white matter regions of the cord in the chronic as well as acute stage. Lesion densities were much higher in the lateral and posterior white matter regions than in the central gray matter region. None of the lesions in MS were T1-hypointense.ConclusionsThese MRI findings strongly suggest a preferential involvement in the spinal central gray matter in NMO which is distinct from MS.

[1]  Y. Itoyama,et al.  Intractable hiccup and nausea with periaqueductal lesions in neuromyelitis optica , 2005, Neurology.

[2]  C. Poser,et al.  Diagnostic criteria for multiple sclerosis , 2001, Clinical Neurology and Neurosurgery.

[3]  Hans Lassmann,et al.  A role for humoral mechanisms in the pathogenesis of Devic's neuromyelitis optica. , 2002, Brain : a journal of neurology.

[4]  H. Grossniklaus.  A role for humoral mechanisms in the pathogenesis of Devic’s neuromyelitis optica. Luchinetti CF,∗ Mandler RN, McGavern D, Bruck W, Gleich G, Ransohoff RM, Trebst C, Weinshenker B, Wingerchuck D, Parisi JE, Lassman H. Brain 2002;125:1450–1461 , 2002 .

[5]  Ichiro Nakashima,et al.  A serum autoantibody marker of neuromyelitis optica: distinction from multiple sclerosis , 2004, The Lancet.

[6]  A. Bar-Or,et al.  Neuromyelitis optica with hypothalamic involvement , 2005, Multiple sclerosis.

[7]  M Filippi,et al.  MRI and magnetization transfer imaging changes in the brain and cervical cord of patients with Devic’s neuromyelitis optica , 1999, Neurology.

[8]  P. Cabre,et al.  Recurrent Optic Neuromyelitis with Endocrinopathies , 1997, Neurology.

[9]  P C O'Brien,et al.  The clinical course of neuromyelitis optica (Devic’s syndrome) , 1999, Neurology.

[10]  Petter Laake,et al.  Temporary loss of perivascular aquaporin-4 in neocortex after transient middle cerebral artery occlusion in mice , 2006, Proceedings of the National Academy of Sciences.

[11]  S. Reingold,et al.  Diagnostic criteria for multiple sclerosis: 2005 revisions to the “McDonald Criteria” , 2005, Annals of neurology.

[12]  Y. Itoyama,et al.  An autopsied case of neuromyelitis optica with a large cavitary cerebral lesion , 2005 .

[13]  Massimo Filippi,et al.  Clinical characteristics, course and prognosis of relapsing Devic’s Neuromyelitis Optica , 2004, Journal of Neurology.

[14]  K. Takemori,et al.  Expression of glucose transporter-1 and aquaporin-4 in the cerebral cortex of stroke-prone spontaneously hypertensive rats in relation to the blood-brain barrier function. , 2006, American journal of hypertension.

[15]  V. Simnad,et al.  Multiple Sclerosis Presenting as Transverse Myelopathy , 1997, Neurology.

[16]  B. Weinshenker,et al.  Revised diagnostic criteria for neuromyelitis optica , 2006, Neurology.

[17]  M Filippi,et al.  Magnetization transfer and diffusion tensor MRI show gray matter damage in neuromyelitis optica , 2004, Neurology.

[18]  James Lowe,et al.  Spinal Cord Gray Matter Demyelination in Multiple Sclerosis—A Novel Pattern of Residual Plaque Morphology , 2006, Brain pathology.

[19]  David W. McCandless,et al.  Book Review: Neuroanatomy: An Atlas of Structures, Sections, and Systems 5th Edition, Duane E. Haines, Lippincott Williams & Wilkins, Baltimore, 2000 , 1999, Metabolic Brain Disease.

[20]  M. Filippi,et al.  MR imaging of Devic’s neuromyelitis optica , 2004, Neurological Sciences.

[21]  B. Weinshenker,et al.  Neuromyelitis optica brain lesions localized at sites of high aquaporin 4 expression. , 2006, Archives of neurology.

[22]  R S Howard,et al.  Clinical, CSF, and MRI findings in Devic's neuromyelitis optica. , 1996, Journal of neurology, neurosurgery, and psychiatry.

[23]  A. Zinn,et al.  Early Androgen Deficiency in Infants and Young Boys with 47,XXY Klinefelter Syndrome , 2005, Hormone Research in Paediatrics.

[24]  Y. Itoyama,et al.  Loss of aquaporin-4 in active perivascular lesions in neuromyelitis optica: a case report. , 2006, The Tohoku journal of experimental medicine.

[25]  P. Vermersch,et al.  Prospective study of patients presenting with acute partial transverse myelopathy , 2003, Journal of Neurology.

[26]  M. Filippi,et al.  Grading cervical cord damage in neuromyelitis optica and MS by diffusion tensor MRI , 2006, Neurology.

[27]  R. Knobler,et al.  Multiple sclerosis in the spinal cord: MR appearance and correlation with clinical parameters. , 1995, Radiology.

[28]  Y. Itoyama,et al.  Oligoclonal IgG bands in Japanese patients with multiple sclerosis. A comparative study between isoelectric focusing with IgG immunofixation and high-resolution agarose gel electrophoresis , 2005, Journal of Neuroimmunology.

[29]  R. Mandler,et al.  Devic's neuromyelitis optica: A clinicopathological study of 8 patients , 1993, Annals of neurology.

[30]  Y. Itoyama,et al.  Pure optic-spinal form of multiple sclerosis in Japan. , 2002, Brain : a journal of neurology.

[31]  A. Verier,et al.  Devic's neuromyelitis optica: clinical, laboratory, MRI and outcome profile , 2002, Journal of the Neurological Sciences.

[32]  A. Verkman,et al.  The Journal of Experimental Medicine CORRESPONDENCE , 2005 .

[33]  Y. Itoyama,et al.  Clinical and MRI study of brain stem and cerebellar involvement in Japanese patients with multiple sclerosis , 1999, Journal of neurology, neurosurgery, and psychiatry.

[34]  A. J. Thompson,et al.  T1 hypointensity of the spinal cord in multiple sclerosis , 2001, Journal of Neurology.

[35]  G. Manley,et al.  Aquaporin-4 deletion in mice reduces brain edema after acute water intoxication and ischemic stroke , 2000, Nature Medicine.