Journal of neuroimaging : official journal of the American Society of Neuroimaging
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Multiple sclerosis (MS) is a chronic neurological condition characterized pathologically by axonal loss, demyelination, inflammation, and gliosis. Magnetic resonance imaging (MRI) has had a major impact on diagnosing MS, understanding the condition, and monitoring the effects of treatments. Recently, spinal cord MRI has received increased attention. ⋯ Despite the technical difficulties of performing spinal cord MRI, imaging studies, particularly of the cervical cord, are becoming more common. Significant focus has been placed on measuring cord atrophy, and reproducible techniques have been developed to measure the cervical cord CSA. Spinal cord MRI may provide information about disease progression that is not readily available from brain MRI scans and could be useful in diagnosing MS in some cases, as well as for monitoring the effects of treatments.
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Evaluation of brain and spinal cord atrophy by magnetic resonance imaging (MRI) has become an increasingly important component of understanding the multiple sclerosis (MS) disease process. These destructive aspects of the disease develop early in the disease course. A growing body of data links brain and spinal cord atrophy to clinical impairment more closely than can be linked with conventional measures of overt lesions. ⋯ They compare the rate of atrophy among MS phenotypes and summarize the emerging data linking atrophy to neurological and neuropsychological impairment. Finally, they discuss the effect of disease-modifying immunotherapies on the rate of CNS atrophy in patients with MS. Future research to clarify the etiology and pathophysiology of brain and spinal cord atrophy should provide new targets for therapeutic development.
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In multiple sclerosis (MS), the spinal cord is a common area of involvement, and its dysfunction is likely to be responsible for much of motor disability. It has been reported that atrophy in the cervical spinal cord occurs early and is detectable in patients presenting with a clinically isolated syndrome. ⋯ This review summarizes the underlying pathology responsible for spinal cord atrophy and the methods available to measure it. The relationships between spinal cord atrophy, other magnetic resonance imaging parameters, and clinical disability are also discussed.
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Nitrous oxide (N2O) is inhaled in anesthesia and as a recreational drug from whipped cream dispensers. Its abuse reaches approximately 10% in some age groups. By inactivating cobalamin (Cbl) (vitamin B12), N2O can cause neurologic and hematologic manifestations. We present a case of N2O-induced Cbl deficiency presenting as cervical myelopathy. ⋯ This patient presented with the symptoms and signs of Cbl deficiency. The MRI lesions in the posterior columns aided the diagnosis. Physicians need to have a high level of suspicion in cases of unexplained Cbl deficiency and myelopathy.
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The thrombolysis in myocardial infarction (TIMI) grading scheme and other classification systems have limitations in evaluating patients with ischemic stroke because they do not account for occlusion location or collateral circulation. The Qureshi grading scheme has been recently proposed to evaluate the severity of arterial occlusion in acute ischemic stroke because of limitations in existing grading systems. ⋯ The Qureshi grading scheme can be effectively used to determine the severity of ischemic stroke (brain at risk) from the initial angiography.