Central trigeminal involvement in multiple sclerosis using high-resolution MRI at 3 T

Mills, Roger; Young, Carolyn A; Smith, Elizabeth

doi:10.1259/bjr/65228893

Cited by 53 publications

(41 citation statements)

References 14 publications

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“…Moreover, MRI hyperintensities along the trigeminal nerve roots have been reported in patients with MS (18,(26)(27)(28). It is known that TN occurs more frequently in MS setting than in general population (18,29).…”

Section: Discussionmentioning

confidence: 99%

Can pontine trigeminal T2-hyperintensity suggest herpetic etiology of trigeminal neuralgia?

D’Amico

Russo

Ugga

et al. 2016

Quant. Imaging Med. Surg.

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Background: Trigeminal neuralgia (TN) is usually classified into two different categories: idiopathic and secondary. We have investigated the frequency of brainstem pontine lesions in patients with idiopathic TN without multiple sclerosis (MS) or stroke, and their association with herpes zoster (HZ) infection.Methods: Brain magnetic resonance imaging (MRI) studies of 28 patients with TN were retrospectively reviewed. Results:We found seven patients with clinical suspicion of HZ infection and pontine T2 hyperintense lesions, associated with nerve atrophy in one case. Fifteen patients had a neurovascular conflict (NVC) without brainstem involvement, two of them associated with trigeminal atrophy, while four patients had only volumetric reduction of the nerve. In all patients MRI findings were ipsilateral to the side of TN.Conclusions: Pontine T2 hyperintensities could be considered as a MRI sign of TN in patients without NVCs. This "trigeminal pontine sign" (TPS) is frequently found in association with herpetic infections. Methods MRI brain scans of twenty-eight patients (18F, 10M; mean age 52.8±14 years; range of age 26-80 years) with TN without MS or brainstem infarction were retrospectively reviewed by two neuroradiologists with 20 and 24 years of experience, respectively.Eighteen patients (12F, 6M; mean age 50 years; range of age 26-77 years) had idiopathic TN while ten patients (6F, 4M; mean age 50 years; range of age 34-63 years) had a clinical suspicion of a herpes zoster (HZ) infection; only four of these ten patients performed lumbar puncture that confirmed the diagnosis.In all cases a brain MRI was performed (Gyroscan Intera, 1.5 T, Philips Medical System, Best, The Netherlands), including FLAIR (TR: 8,005 ms, TE: 100 ms, TI: 2,200 ms, matrix: 256×192, slice thickness: 5 mm), Fast Spin-Echo (FSE) T1-and T2-weighted (TR: 583-4,454 ms, TE: 15-100 ms, matrix: 244×194−384×288, slice thickness: 5 mm, respectively) sequences; axial three-dimensional (3D) FSE T2 with a driven equilibrium pulse (DRIVE) sequence (TE: 250; TR: 1,500; flip angle: 90°; matrix: 256×256; slice thickness: 1×1×1 mm; FOV: 130×130) and magnetic resonance angiography (MRA) were performed to depict NVC and nerve atrophy. MRA was performed without contrast medium injection by using a 3-dimensional time-of-flight sequence (3D TOF, TE: 65 ms; TR: 6.9 ms; flip angle: 20°; matrix: 160×160; slice thickness: 1.40 mm; FOV: 175×200 mm). Multi planar reformation (MPR) and maximum intensity projection (MIP) reconstructions were subsequently analyzed.We evaluated the presence of brainstem lesions and their correlation with the side of the pain and the TN category. ResultsSeven patients with HZ infection showed hyperintense pontine areas on turbo spin echo (TSE) T2-weighted and FLAIR images, which we called "trigeminal pontine sign" (TPS), all of them without a NVC. Their data were summarized in Table 1. MRI was always consistent with the side of the pain. These lesions had a linear appearance, involving the pathway from the trigeminal root entry zone (...

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Section: Discussionmentioning

confidence: 99%

Can pontine trigeminal T2-hyperintensity suggest herpetic etiology of trigeminal neuralgia?

D’Amico

Russo

Ugga

et al. 2016

Quant. Imaging Med. Surg.

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“…Besides TN due to NVC, there are other known causes for symptomatic TN, e.g., multiple sclerosis [6,9,17]. MS is a chronic inflammatory disease of the central nervous system characterized by demyelination, axonal dysfunction, and neuronal loss [18].…”

Section: Discussionmentioning

confidence: 99%

“…In patients with MS-related TN, demyelination of the proximal and secondary trigeminal pathways has been demonstrated [1]. MS-associated, T2-hyperintense brainstem lesions as cause of demyelination in the pontine trigeminal pathways only moderately correlate with the clinical presentation of MS-related TN [1,[6][7][8][9].…”

Section: Introductionmentioning

confidence: 99%

Diffusion tensor imaging of the trigeminal nerve in patients with trigeminal neuralgia due to multiple sclerosis

et al. 2014

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“…It is often seen in young patients and it affects ophthalmic branch to a lesser extent. Its mechanisms are still debated and some neuroimaging studies mention demyelinating plaques in the pons of the patients with neuralgia (20). Meaney et al argued that this could be coincidental (21).…”

Section: Discussionmentioning

confidence: 99%

Multipl sklerozda ağrı ve klinik özelliklerle ilişkisi

Akpınar¹,

Tokgöz²,

Gümüş³

2014

tnd

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Objective: Multiple sclerosis (MS) is an autoimmune-neurodegenerative disease of the central nervous system. The prevalence of pain is between 29% and 86% and besides neuropathic pain, somatic pain types may also emerge together or separately. In this study we aimed to analyze the relationship between pain and other clinical features in MS. Ma te ri als and Met hods: One-hundred cases who were followed in MS clinic and who have complaints of pain, were included in this study. We evaluated pain type and localization during patients were filling in the forms. We applied Visual Pain Scale (VPS), Ashworth Spasticity Scale (ASS) and Beck Depression Scale (BDS). Re sults: When female and male patients were compared, there were no statistical differences between age, disease duration and EDDS scores. Seventy seven percent of cases complained of neuropathic pain, 21% of cases had Lhermitte symptoms. Trigeminal neuralgia has been observed in 1% of cases and 55% of neuropathic extremity pain. In 60% of the cases nociceptive pains, in 12% of the cases joint-extremity-muscle pain, in 47% headache and in 1% painful tonic spasms were present. Pain depending on the treatment was observed only in 2% of the cases. The pain score was high in patients with spasticity and depression. Although there was reasonable positive correlation between age, EDDS score and VPS, poor correlation was obtained between disease period and number of attacks. Conclusion: These findings indicate that MS pain is related with spasticity, disability and depression and these clinical findings should be taken into account during pain treatment. (Turkish Journal of Neurology 2014; 20:79-83) Key Words: Multiple sclerosis, pain, neuropathic pain, headache, trigeminal neuralgia Amaç: Multipl Skleroz (MS), santral sinir sisteminin otoimmün-nörodejeneratif bir hastalığıdır. Ağrı prevalansının %29-%86 arasında değiştiği bu hastalıkta nöropatik, somatik ağrı tipleri bir arada veya tek olarak ortaya çıkabilir. Bu çalışmada MS'te ağrı ve diğer klinik özellikler arasındaki ilişkiyi araştırmayı amaçladık. Ge reç ve Yön tem: Çalışmaya MS polikliniğinde takip edilen ve ağrı şikayeti olan 100 olguyu dahil ettik. Olgulara hazırladığımız anket formunu doldurtarak ağrı tipi ve lokalizasyonunu sorguladıktan sonra Vizüel Ağrı Skalası (VAS), Ashworth Spastite Skalası (ASS) ve Beck Depresyon Ölçeği (BDÖ) uyguladık. Bulgular: Kadın ve erkek hastalar karşılaştırıldığında yaş, hastalık süresi, atak sayısı, EDSS skorları arasında istatistiksel olarak anlamlı fark yoktu. Olguların %77'sinde nöropatik ağrı; %21'inde Lhermitte belirtisi, %1'inde trigeminal nevralji, %55'inde nöropatik ekstremite ağrısı vardı. Olguların %60'ında nosiseptif ağrı; %12'sinde yaygın eklem-ekstremite kas ağrısı, %47'sinde baş ağrısı, %1'inde ağrılı tonik spazm mevcuttu. Olguların sadece %2'sinde tedaviye bağlı ağrı vardı. Ağrı skoru, spastisitesi ve depresyonu olanlarda anlamlı derecede yüksekti. Yaş ve EDSS skoru ile VAS arasında orta derecede pozitif korelasyon varken, hastalık süresi ve atak sayısı ile...

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Central trigeminal involvement in multiple sclerosis using high-resolution MRI at 3 T

Cited by 53 publications

References 14 publications

Can pontine trigeminal T2-hyperintensity suggest herpetic etiology of trigeminal neuralgia?

Can pontine trigeminal T2-hyperintensity suggest herpetic etiology of trigeminal neuralgia?

Diffusion tensor imaging of the trigeminal nerve in patients with trigeminal neuralgia due to multiple sclerosis

Multipl sklerozda ağrı ve klinik özelliklerle ilişkisi

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