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Rebound After Fingolimod and a Single Daclizumab Injection in a Patient Retrospectively Diagnosed With NMO Spectrum Disorder—MRI Apparent Diffusion Coefficient Maps in Differential Diagnosis of Demyelinating CNS Disorders

Objective: Differential diagnosis of neuromyelitis optica spectrum disorders (NMOSD) and multiple sclerosis (MS) or mimics can be challenging, especially in patients with atypical presentations and negative serostatus for aquaporin-4 antibodies (AQP4-Ab). This brief research report describes magneti...

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Autores principales: Wagner, Franca, Grunder, Lorenz, Hakim, Arsany, Kamber, Nicole, Horn, Michael P., Muellner, Julia, Hoepner, Robert, Wiest, Roland, Metz, Imke, Chan, Andrew, Salmen, Anke
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6170610/
https://www.ncbi.nlm.nih.gov/pubmed/30319524
http://dx.doi.org/10.3389/fneur.2018.00782
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author Wagner, Franca
Grunder, Lorenz
Hakim, Arsany
Kamber, Nicole
Horn, Michael P.
Muellner, Julia
Hoepner, Robert
Wiest, Roland
Metz, Imke
Chan, Andrew
Salmen, Anke
author_facet Wagner, Franca
Grunder, Lorenz
Hakim, Arsany
Kamber, Nicole
Horn, Michael P.
Muellner, Julia
Hoepner, Robert
Wiest, Roland
Metz, Imke
Chan, Andrew
Salmen, Anke
author_sort Wagner, Franca
collection PubMed
description Objective: Differential diagnosis of neuromyelitis optica spectrum disorders (NMOSD) and multiple sclerosis (MS) or mimics can be challenging, especially in patients with atypical presentations and negative serostatus for aquaporin-4 antibodies (AQP4-Ab). This brief research report describes magnetic resonance imaging (MRI) findings focusing on quantitative apparent diffusion coefficient (ADC) histogram analysis as a potential tool to differentiate NMOSD from MS. Methods: Longitudinal MRI data obtained during routine clinical examinations were retrospectively analyzed in a patient with histologically determined cerebral NMOSD, a patient with an acute tumefactive MS lesion, and a patient with ischemic stroke. Histogram analyses of ADC maps were evaluated. Results: A patient diagnosed with MS experienced a severe rebound after fingolimod withdrawal and a single daclizumab injection. Cerebral NMOSD manifestation was confirmed by brain biopsy. However, the patient did not fulfill consensus criteria for NMOSD and was AQP4-Ab negative. Comparison of ADC histogram analyses of this patient with those from a patient with MS and one with ischemic stroke revealed differential ADC characteristics: namely a more pronounced and prolonged ADC leftward shift in inflammatory than in ischemic pathology, even more accentuated in NMOSD versus MS. Conclusion: ADC map histograms and ADC threshold values for different conditions may be useful for differentiation of large inflammatory brain lesions and further studies are merited.
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spelling pubmed-61706102018-10-12 Rebound After Fingolimod and a Single Daclizumab Injection in a Patient Retrospectively Diagnosed With NMO Spectrum Disorder—MRI Apparent Diffusion Coefficient Maps in Differential Diagnosis of Demyelinating CNS Disorders Wagner, Franca Grunder, Lorenz Hakim, Arsany Kamber, Nicole Horn, Michael P. Muellner, Julia Hoepner, Robert Wiest, Roland Metz, Imke Chan, Andrew Salmen, Anke Front Neurol Neurology Objective: Differential diagnosis of neuromyelitis optica spectrum disorders (NMOSD) and multiple sclerosis (MS) or mimics can be challenging, especially in patients with atypical presentations and negative serostatus for aquaporin-4 antibodies (AQP4-Ab). This brief research report describes magnetic resonance imaging (MRI) findings focusing on quantitative apparent diffusion coefficient (ADC) histogram analysis as a potential tool to differentiate NMOSD from MS. Methods: Longitudinal MRI data obtained during routine clinical examinations were retrospectively analyzed in a patient with histologically determined cerebral NMOSD, a patient with an acute tumefactive MS lesion, and a patient with ischemic stroke. Histogram analyses of ADC maps were evaluated. Results: A patient diagnosed with MS experienced a severe rebound after fingolimod withdrawal and a single daclizumab injection. Cerebral NMOSD manifestation was confirmed by brain biopsy. However, the patient did not fulfill consensus criteria for NMOSD and was AQP4-Ab negative. Comparison of ADC histogram analyses of this patient with those from a patient with MS and one with ischemic stroke revealed differential ADC characteristics: namely a more pronounced and prolonged ADC leftward shift in inflammatory than in ischemic pathology, even more accentuated in NMOSD versus MS. Conclusion: ADC map histograms and ADC threshold values for different conditions may be useful for differentiation of large inflammatory brain lesions and further studies are merited. Frontiers Media S.A. 2018-09-27 /pmc/articles/PMC6170610/ /pubmed/30319524 http://dx.doi.org/10.3389/fneur.2018.00782 Text en Copyright © 2018 Wagner, Grunder, Hakim, Kamber, Horn, Muellner, Hoepner, Wiest, Metz, Chan and Salmen. http://creativecommons.org/licenses/by/4.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Neurology
Wagner, Franca
Grunder, Lorenz
Hakim, Arsany
Kamber, Nicole
Horn, Michael P.
Muellner, Julia
Hoepner, Robert
Wiest, Roland
Metz, Imke
Chan, Andrew
Salmen, Anke
Rebound After Fingolimod and a Single Daclizumab Injection in a Patient Retrospectively Diagnosed With NMO Spectrum Disorder—MRI Apparent Diffusion Coefficient Maps in Differential Diagnosis of Demyelinating CNS Disorders
title Rebound After Fingolimod and a Single Daclizumab Injection in a Patient Retrospectively Diagnosed With NMO Spectrum Disorder—MRI Apparent Diffusion Coefficient Maps in Differential Diagnosis of Demyelinating CNS Disorders
title_full Rebound After Fingolimod and a Single Daclizumab Injection in a Patient Retrospectively Diagnosed With NMO Spectrum Disorder—MRI Apparent Diffusion Coefficient Maps in Differential Diagnosis of Demyelinating CNS Disorders
title_fullStr Rebound After Fingolimod and a Single Daclizumab Injection in a Patient Retrospectively Diagnosed With NMO Spectrum Disorder—MRI Apparent Diffusion Coefficient Maps in Differential Diagnosis of Demyelinating CNS Disorders
title_full_unstemmed Rebound After Fingolimod and a Single Daclizumab Injection in a Patient Retrospectively Diagnosed With NMO Spectrum Disorder—MRI Apparent Diffusion Coefficient Maps in Differential Diagnosis of Demyelinating CNS Disorders
title_short Rebound After Fingolimod and a Single Daclizumab Injection in a Patient Retrospectively Diagnosed With NMO Spectrum Disorder—MRI Apparent Diffusion Coefficient Maps in Differential Diagnosis of Demyelinating CNS Disorders
title_sort rebound after fingolimod and a single daclizumab injection in a patient retrospectively diagnosed with nmo spectrum disorder—mri apparent diffusion coefficient maps in differential diagnosis of demyelinating cns disorders
topic Neurology
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6170610/
https://www.ncbi.nlm.nih.gov/pubmed/30319524
http://dx.doi.org/10.3389/fneur.2018.00782
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