Hypothalamic lesions in multiple sclerosis

Qiu, Wei; Raven, Sonja; Wu, Jing-Shan; Bundell, Christine; Hollingsworth, Peter; Carroll, William M.; Mastaglia, Frank; Kermode, Allan G.

doi:10.1136/jnnp.2009.198192

Cited by 35 publications

(25 citation statements)

References 23 publications

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“…For example, if characteristic periependymal or hypothalamic disease is apparent, our data would suggest a diagnosis of NMO/AQP4 antibody associated disease to be highly likely. However, other authors have found hypothalamic lesions in 13.3% of 105 Caucasian patients with classical MS [26]. As this data indicates that hypothalamic lesions can be seen in classical MS, and our series is biased, we do not conclude that the presence of hypothalamic disease alone excludes the diagnosis of MS.…”

Section: Discussioncontrasting

confidence: 60%

Diagnosis of neuromyelitis optica (NMO) spectrum disorders: is MRI obsolete?

et al. 2011

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Section: Discussioncontrasting

confidence: 60%

Diagnosis of neuromyelitis optica (NMO) spectrum disorders: is MRI obsolete?

et al. 2011

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“…For example, the corpus callosum was suggested to be a differentiating point between NMO and MS [2]. In our previous study using conventional MRI protocols, hypothalamic lesions could be detected in 13.3% of MS patients but were not found in any patients with NMO [3]. Thus, our results do not support the suggestion that hypothalamic lesions were specific to NMO.…”

Section: Introductioncontrasting

confidence: 75%

Brain MRI in Neuromyelitis Optica: What is its Role?

Qiu

Kermode

2011

Curr Neurol Neurosci Rep

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“…Pittock and colleagues reported that 60% of NMO patients show brain abnormalities on MRI, with about 10% developing NMO-unique hypothalamic, corpus callosal, periventricular, or brainstem lesions (74) in regions enriched for the target antigen, AQP4 (76, 81, 108). However, in contrast to MS, NMO brain lesions may be reversible.…”

Section: Anatomical Distribution Of Nmo Lesions In the Cnsmentioning

confidence: 99%

The Pathology of an Autoimmune Astrocytopathy: Lessons Learned from Neuromyelitis Optica

et al. 2013

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Neuromyelitis optica (NMO) is a disabling autoimmune astrocytopathy characterized by typically severe and recurrent attacks of optic neuritis and longitudinally-extensive myelitis. Until recently, NMO was considered an acute aggressive variant of multiple sclerosis (MS), despite the fact that early studies postulated that NMO and MS may be two distinct diseases with a common clinical picture. With the discovery of a highly specific serum autoantibody (NMO-IgG), Lennon and colleagues provided the first unequivocal evidence distinguishing NMO from MS and other CNS inflammatory demyelinating disorders. The target antigen of NMO-IgG was confirmed to be aquaporin-4 (AQP4), the most abundant water channel protein in the central nervous system (CNS), mainly expressed on astrocytic foot processes at the blood brain barrier, subpial and subependymal regions. Pathological studies demonstrated that astrocytes were selectively targeted in NMO as evidenced by the extensive loss of immunoreactivities for the astrocytic proteins, AQP4 and glial fibrillary acidic protein (GFAP), as well as perivascular deposition of immunoglobulins and activation of complement even within lesions with a relative preservation of myelin. In support of these pathological findings, GFAP levels in the cerebrospinal fluid (CSF) during acute NMO exacerbations were found to be remarkably elevated in contrast to MS where CSF-GFAP levels did not substantially differ from controls. Additionally, recent experimental studies showed that AQP4 antibody is pathogenic, resulting in selective astrocyte destruction and dysfunction in vitro, ex vivo, and in vivo. These findings strongly suggest that NMO is an autoimmune astrocytopathy where damage to astrocytes exceeds both myelin and neuronal damage. This chapter will review recent neuropathological studies that have provided novel insights into the pathogenic mechanisms, cellular targets, as well as the spectrum of tissue damage in NMO.

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Hypothalamic lesions in multiple sclerosis

Abstract: Hypothalamic lesions in MS are more frequent than previously reported and are not associated with NMO-IgG antibody.

Cited by 35 publications

References 23 publications

Diagnosis of neuromyelitis optica (NMO) spectrum disorders: is MRI obsolete?

Diagnosis of neuromyelitis optica (NMO) spectrum disorders: is MRI obsolete?

Brain MRI in Neuromyelitis Optica: What is its Role?

The Pathology of an Autoimmune Astrocytopathy: Lessons Learned from Neuromyelitis Optica

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