engleski

Recurrent non-multiple sclerosis demyelinating diseases

Recurrences of episodes of demyelinating disease in adults have frequently been interpreted as signifying the diagnosis of MS. The introduction of MRI has revealed that (RDEM) or multiphasic (MDEM) forms of disseminated encephalomyelitis (DEM) are more common than suspected. The images of DEM are quite characteristic and in most instances are quite different from those usually seen in MS. In addition, there are a number of clinical features that are useful in differentiating R- and MDEM from MS: among those are associated systemic symptoms such as fever, malaise, nausea, CSF leukocytosis and elevated protein. CSF oligoclonal bands are usually absent. Several examples of R- and MDEM will be shown to demonstrate the various MRI patterns that can be encountered. It is remarkable that the confusion between R-and MDEM and MS persists despite the existence of published reports of recurrent DEM dating back 70 years, as well as that of an experimental model. Many of the articles contain typical MR images. In many instances the MRIs have been incorrectly diagnosed as brain tumors leading to biopsy, misnamed Marburg's disease because of the accelerated clinical course, Schilder's disease on the basis of the large size of the "lesion, " or, most commonly MS. Possible mechanisms for recurrence include localization to the site of a previous injury to the nervous system, or by the phenomenon of molecular mimicry. The importance of differentiating between R-and MDEM and MS is greater today in view of the suggestion that immunodulatory treatment be initiated in patients with a clinically isolated syndrome (CIS), or that a second episode means that they have MS. Despite recurrences, the prognosis of DEM remains far better than that of MS.

recurrent disseminated encephalomyelitis; multiphasic disseminated encephalomyelitis; multiple sclerosis

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