An early‐onset case of multiple sclerosis with thalamic lesions on MRI

Abstract

We present here an early-onset case of multiple sclerosis (MS) with thalamic lesions. The patient first experienced an episode of ataxic gait at 2 years 3 months of age, with spontaneous remission within 1 month. At 5 years 4 months, she was admitted because of cerebellar ataxia, oculomotor restriction and feeding difficulty. Magnetic resonance imaging (MRI) showed multiple well-defined lesions in the white matter of the cerebellum, mid-brain, periventricle and right frontal lobe. Cerebrospinal fluid (CSF) showed a mild elevation of both immunoglobulin G (IgG) and myelin basic protein (MBP). Serum anti-myelin antibody was also positive, although leukocytosis and elevation of C-reactive protein were not found. Methylprednisolone pulse therapy relieved symptoms within 2 weeks and the abnormal MRI and CSF findings gradually improved. At 6 years 6 months of age, she incurred a third episode of cerebellar ataxia and disturbance of consciousness. Magnetic resonance imaging revealed recurrence and extension of the previous lesions as well as new lesions in the thalamus and internal capsule. CSF IgG and MBP level showed a higher elevation than in the second episode. The combination of the cerebellar, brain-stem, cerebral and thalamic lesions with remission and exacerbation, supported by MRI and CSF findings, allowed the diagnosis of clinically definite MS to be made. This is one of the youngest cases of MS yet described, with the first attack occurring at 27 months of age. In addition, this case is unique for the involvement of the gray matter in the thalamus.

Localized 1 H magnetic resonance spectroscopy in mainly cortical gray matter of patients with multiple sclerosis

“…Using the conventional, T2-weighted, spin-echo sequence, the presence of demyelinating plaques was demonstrated in the gray matter of some MS patients [48]. The localization of the demyelinating process of MS in the deep gray matter, in particular the thalamus, also emerged in an early-onset case of multiple sclerosis [4]. Furthermore, there is a case report of an R-R MS patient with an initial presentation of myelopathy who had demyelinating lesions located in spinal cord gray matter [54].…”

Adult post‐infectious thalamic encephalitis: acute onset and benign course

“…, 1994; Tenembaum et al. , 2002), whereas in multiple sclerosis it is rare (Asai et al. , 1994; Masson and Colombani, 2002).…”

“…As grey matter also contains myeline and oligodendrocytes, the same perivenous inflammatory process and MRI signal abnormalities can occur as in white matter. In cases of ADEM, involvement of deep grey matter nuclei revealed by MRI interestingly seems to be common (Baum et al, 1994;Tenembaum et al, 2002), whereas in multiple sclerosis it is rare (Asai et al, 1994;Masson and Colombani, 2002). Recent studies using diffusiontensor imaging in patients with ADEM have demonstrated the presence of microscopic tissue damage in the basal ganglia of patients with ADEM but not in MS patients with a similar burden of MRI visible brain lesions (Holtmannspotter et al, 2003).…”

Noncovalent Protein Arginine Deiminase (PAD) Inhibitors Are Efficacious in Animal Models of Multiple Sclerosis

“…Corroborating the patterns in the LFB stained brain sections (Figure ), CD3 markers saw the greatest reduction in the cerebellum (Figure A–C) and internal capsule (Figure D–F) regions of the brains of the mice treated with 23 . Although this is an animal model of MS and primarily considered as an inflammation-driven MS model, it is well-characterized that disease pathology such as lesions appearance is localized to cerebellum and internal capsule areas of the brain. − …”