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Clinical, radiographic characteristics and immunomodulating changes in neuromyelitis optica with extensive brain lesions

BACKGROUND: Neuromyelitis optica (NMO) shows various brain magnetic resonance imaging (MRI) abnormalities with recurrent central nervous system (CNS) attacks, although predominantly affecting the spinal cord and optic nerve. However, NMO with extensive involvement of the brain has infrequently been...

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Autores principales: Cheng, Chen, Jiang, Ying, Chen, Xiaohong, Dai, Yongqiang, Kang, Zhuang, Lu, Zhengqi, Peng, Fuhua, Hu, Xueqiang
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2013
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3725153/
https://www.ncbi.nlm.nih.gov/pubmed/23819854
http://dx.doi.org/10.1186/1471-2377-13-72
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author Cheng, Chen
Jiang, Ying
Chen, Xiaohong
Dai, Yongqiang
Kang, Zhuang
Lu, Zhengqi
Peng, Fuhua
Hu, Xueqiang
author_facet Cheng, Chen
Jiang, Ying
Chen, Xiaohong
Dai, Yongqiang
Kang, Zhuang
Lu, Zhengqi
Peng, Fuhua
Hu, Xueqiang
author_sort Cheng, Chen
collection PubMed
description BACKGROUND: Neuromyelitis optica (NMO) shows various brain magnetic resonance imaging (MRI) abnormalities with recurrent central nervous system (CNS) attacks, although predominantly affecting the spinal cord and optic nerve. However, NMO with extensive involvement of the brain has infrequently been studied. We investigated the clinical, radiographic features and immunomodulating changes of NMO patients with extensive brain lesions (EBLs) in China. METHODS: NMO patients (including 16 NMO patients with EBLs and 53 NMO patients without EBLs) hospitalized during January 2006 and February 2010 were recruited and analyzed retrospectively. Data of clinical characteristics, magnetic resonance imaging (MRI) features, laboratory abnormalities, treatment details and outcomes were analyzed. All the patients received the follow-up visits for two years. RESULTS: EBLs in NMO were classified into four categories according to their respective MRI characteristics: 1) Tumefactive-like lesions (n=4, 25%); 2) Acute disseminated encephalomyelitis (ADEM)-like lesions (n=6, 37.5%); 3) Multiple sclerosis (MS)-like lesions (n=5, 31.25%); 4) Posterior reversible encephalopathy syndrome (PRES)-like lesions (n=1, 6.25%). NMO patients with EBLs had higher rates of encephalopathy symptoms (37.5% vs. 5.6%, p = 0.004), homonymous hemianopia (18.8% vs. 0%, p = 0.011) and AQP4 seropositivity (100% vs. 69.8%, p = 0.008) than NMO patients without EBLs (NEBLs). Immunomodulating changes (including the levels of C3, C4, ESR and CRP) were significantly higher in patients with EBLs than those without EBLs. The relapse times in EBLs during the follow-up period were more frequent than those happened in NEBLs (1.88 ± 0.30 vs. 1.23 ± 0.14, p = 0.04). The EDSS scores in EBLs patients were also much higher than those in NEBLs throughout all the whole visits of follow-up. CONCLUSIONS: The presence of EBLs in NMO may indicate a higher diseases activity and portend a worse prognosis. CRP is a useful marker in monitoring diseases activity. Systemic inflammation may be crucial to the formation of EBLs in NMO.
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spelling pubmed-37251532013-07-28 Clinical, radiographic characteristics and immunomodulating changes in neuromyelitis optica with extensive brain lesions Cheng, Chen Jiang, Ying Chen, Xiaohong Dai, Yongqiang Kang, Zhuang Lu, Zhengqi Peng, Fuhua Hu, Xueqiang BMC Neurol Research Article BACKGROUND: Neuromyelitis optica (NMO) shows various brain magnetic resonance imaging (MRI) abnormalities with recurrent central nervous system (CNS) attacks, although predominantly affecting the spinal cord and optic nerve. However, NMO with extensive involvement of the brain has infrequently been studied. We investigated the clinical, radiographic features and immunomodulating changes of NMO patients with extensive brain lesions (EBLs) in China. METHODS: NMO patients (including 16 NMO patients with EBLs and 53 NMO patients without EBLs) hospitalized during January 2006 and February 2010 were recruited and analyzed retrospectively. Data of clinical characteristics, magnetic resonance imaging (MRI) features, laboratory abnormalities, treatment details and outcomes were analyzed. All the patients received the follow-up visits for two years. RESULTS: EBLs in NMO were classified into four categories according to their respective MRI characteristics: 1) Tumefactive-like lesions (n=4, 25%); 2) Acute disseminated encephalomyelitis (ADEM)-like lesions (n=6, 37.5%); 3) Multiple sclerosis (MS)-like lesions (n=5, 31.25%); 4) Posterior reversible encephalopathy syndrome (PRES)-like lesions (n=1, 6.25%). NMO patients with EBLs had higher rates of encephalopathy symptoms (37.5% vs. 5.6%, p = 0.004), homonymous hemianopia (18.8% vs. 0%, p = 0.011) and AQP4 seropositivity (100% vs. 69.8%, p = 0.008) than NMO patients without EBLs (NEBLs). Immunomodulating changes (including the levels of C3, C4, ESR and CRP) were significantly higher in patients with EBLs than those without EBLs. The relapse times in EBLs during the follow-up period were more frequent than those happened in NEBLs (1.88 ± 0.30 vs. 1.23 ± 0.14, p = 0.04). The EDSS scores in EBLs patients were also much higher than those in NEBLs throughout all the whole visits of follow-up. CONCLUSIONS: The presence of EBLs in NMO may indicate a higher diseases activity and portend a worse prognosis. CRP is a useful marker in monitoring diseases activity. Systemic inflammation may be crucial to the formation of EBLs in NMO. BioMed Central 2013-07-03 /pmc/articles/PMC3725153/ /pubmed/23819854 http://dx.doi.org/10.1186/1471-2377-13-72 Text en Copyright © 2013 Cheng et al.; licensee BioMed Central Ltd. http://creativecommons.org/licenses/by/2.0 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Research Article
Cheng, Chen
Jiang, Ying
Chen, Xiaohong
Dai, Yongqiang
Kang, Zhuang
Lu, Zhengqi
Peng, Fuhua
Hu, Xueqiang
Clinical, radiographic characteristics and immunomodulating changes in neuromyelitis optica with extensive brain lesions
title Clinical, radiographic characteristics and immunomodulating changes in neuromyelitis optica with extensive brain lesions
title_full Clinical, radiographic characteristics and immunomodulating changes in neuromyelitis optica with extensive brain lesions
title_fullStr Clinical, radiographic characteristics and immunomodulating changes in neuromyelitis optica with extensive brain lesions
title_full_unstemmed Clinical, radiographic characteristics and immunomodulating changes in neuromyelitis optica with extensive brain lesions
title_short Clinical, radiographic characteristics and immunomodulating changes in neuromyelitis optica with extensive brain lesions
title_sort clinical, radiographic characteristics and immunomodulating changes in neuromyelitis optica with extensive brain lesions
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3725153/
https://www.ncbi.nlm.nih.gov/pubmed/23819854
http://dx.doi.org/10.1186/1471-2377-13-72
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