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RIS away or on-way to MS
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Abstracts / Journal of the Neurological Sciences 405S (2019) 116542
Conclusion Our study shows that 29,4% of patients had an alternative diagnosis. The most common mimickers of MS in our center is not different from what has been described in other countries. Neurological signs and symptoms, age, family story, DNA analysis, laboratory and radiological findings can help with the true diagnosis. doi:10.1016/j.jns.2019.10.1448
WCN19-2132 Journal of the Neurological Sciences 405S (2019) 105110 Poster Session 3 RIS away or on-way to MS A. Alskaf Neurological resident, Neurology department, Homs, Syria
Risk factors groups and percentage to MS conversion still recommended.Patients who start DMT earlier do better than those delayed.The opportunity to intervene earlier is our goal to prevent early disability and death.(BY:Dr–ASMA ALSKAF)
Abstracts / Journal of the Neurological Sciences 405S (2019) 116542
Introduction Radiologically Isolated Syndrome “RIS” describe incidental MRI findings strongly suggestive of MS in patients with normal neurologic examination.Healthy patients have MRI procedure mainly(up to 60%) because of Headaches, cognitive deficit, increased anxiety and depression.Two-thirds of RIS patients show radiological progression and one-third develop clinical symptoms in 5 years. What the prognosis of RIS is?and should DMT be started at earliest possible stage?. Methods A study-report of 70 RIS patients undergo paraclinical studies (blood,CSF,and VEP)and MRI follow-up every(3–6)months. Results 33% of patients had clinical conversion:6 optic neuritis,6 myelitis,5 brainstem symptoms,4 sensitive symptoms,1 cerebellar and 1 cognitive deterioration. VEP,gadolinium enhancement and infratentorial lesions were significant for clinical conversion to MS.IgG and OCB in CSF were significant when associated with 9 T2 lesions on first MRI.Decreased brain volume and thalamic atrophy presented in early stages of disease. Discussion Risk factors for both Radiologic and Clinical progression: * * * * * * * * *
More than 9 T2 lesions. Gadolinium enhancing lesions. Risk factors of Clinical progression: Cervical spine lesions. Infratentorial lesions. Pathologic VEP. High number of lesions. Younger age. O.C.B and/or IgG index with 9 T2 lesions.
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discomfort, dyspnea, orthopnea and palpitation. On physical examination, the patient was in respiratory distress associated with tachycardia of 115/min, BP was 130\90, afebrile. Cardiac examination showed normal S1 an S2 heart sounds, with no murmurs, no JVP distention noted. However, the respiratory examination revealed fine basal lung crepitation bilaterally as well as bilateral lower edema in keeping with pulmonary edema. Neurological exam was stable. ECG showed sinus tachycardia and elevated ST segment elevation in all leads. Her echocardiogram was highly suggestive of acute myocarditis with reduced left ventricular ejection fraction (EF 30%) and pericardial effusion suggestive of associated pericarditis. She had a raised troponin level. Her relevant lab investigations to reveal a possible cause of myocarditis and pericarditis such as infectious and vasculitis workup all came back negative. Patient was treated in the cardiac critical unit (CCU) and her condition stabilized after 10 days with bed rest, anticoagulation, anti-platelets, diuretics and ACE inhibitor. A repeated ECG upon discharge was normal, and a follow up echocardiogram 3 weeks later showed marked improvement with normal left ventricular ejection fraction (EF 45%). This serious adverse effect has already been reported in cases other than Multiple Sclerosis which were treated with the same medication. But only few cases reported in MS patients which mandates strict monitoring at baseline and on regular basis. doi:10.1016/j.jns.2019.10.1450
WCN19-2138 Journal of the Neurological Sciences 405S (2019) 105112 Poster Session 3 Transorbital ultrasound in acute optic neuritis
DMT shows efficacy in brain atrophy patients.Thoracic spine lesions are advised to have DMT.Some suggest 6-months MRI followup;if dissemination in time proved Radiologically;DMT should be initiated at those of predictive findings in CSF(newly defined including IL-8 and chitinase 3-like-1 protein). doi:10.1016/j.jns.2019.10.1449
WCN19-2141 Journal of the Neurological Sciences 405S (2019) 105111 Poster Session 3 Alemtuzumab induced myocarditis and myocardial dysfunction in a patient with multiple sclerosis: A case report a
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B. Mohamed , I. Alsharoqi , R. Matar , F. Almosawi a Salmanya Medical complex, Neuroscienence department, Manama, Bahrain b Salmanya Medical complex, Neuroscience department, Manama, Bahrain c Salmanya medical complex, Family Medicine department, Manama, Bahrain Two months after administering the first cycle of Alemtuzumab IV infusion at a dose of 12 mg\d for 5 days for MS treatment, a 28year-old female presented with 1-day history of sudden severe chest
Y.H. Kim Hangang Sacred Heart Hospital, Department of neurology, Seoul, Republic of Korea Introduction Visual evoked potentials (VEP), optical coherence tomography (OCT), and the magnetic resonance imaging have been used to evaluate functional and morphologic status of the afferent visual pathway, however these utilities have some limitation to evaluate optic nerve pathology in early stage. Recently transorbital ultrasound (TOUS) has been introduced as a promising tool to evaluate optic bulb and nerve. Objective To assess the practical diagnostic value of TOUS in patients with ON along with other diagnostic tools such as VEP, and OCT. Methods TOUS, OCT, and VEP were performed in both eyes of 8 patients with acute ON. The optic nerve were scanned bilaterally in transorbital view to obtain axial image. The optic nerve diameter was measured at point 3 mm posterior to eye globe with and without nerve sheath. All measured parameters were compared between affected and non-affected side. Results Eight patients (4 men, median age 43.5 years) were recruited. The median diameter of the optic nerve without sheath on the affected side (median 3.28 mm) was significantly larger compare to the nonaffected side (median 3.08 mm; p = .003). The diameter with sheath
Abstracts / Journal of the Neurological Sciences 405S (2019) 116542
Conclusion Our study shows that 29,4% of patients had an alternative diagnosis. The most common mimickers of MS in our center is not different from what has been described in other countries. Neurological signs and symptoms, age, family story, DNA analysis, laboratory and radiological findings can help with the true diagnosis. doi:10.1016/j.jns.2019.10.1448
WCN19-2132 Journal of the Neurological Sciences 405S (2019) 105110 Poster Session 3 RIS away or on-way to MS A. Alskaf Neurological resident, Neurology department, Homs, Syria
Risk factors groups and percentage to MS conversion still recommended.Patients who start DMT earlier do better than those delayed.The opportunity to intervene earlier is our goal to prevent early disability and death.(BY:Dr–ASMA ALSKAF)
Abstracts / Journal of the Neurological Sciences 405S (2019) 116542
Introduction Radiologically Isolated Syndrome “RIS” describe incidental MRI findings strongly suggestive of MS in patients with normal neurologic examination.Healthy patients have MRI procedure mainly(up to 60%) because of Headaches, cognitive deficit, increased anxiety and depression.Two-thirds of RIS patients show radiological progression and one-third develop clinical symptoms in 5 years. What the prognosis of RIS is?and should DMT be started at earliest possible stage?. Methods A study-report of 70 RIS patients undergo paraclinical studies (blood,CSF,and VEP)and MRI follow-up every(3–6)months. Results 33% of patients had clinical conversion:6 optic neuritis,6 myelitis,5 brainstem symptoms,4 sensitive symptoms,1 cerebellar and 1 cognitive deterioration. VEP,gadolinium enhancement and infratentorial lesions were significant for clinical conversion to MS.IgG and OCB in CSF were significant when associated with 9 T2 lesions on first MRI.Decreased brain volume and thalamic atrophy presented in early stages of disease. Discussion Risk factors for both Radiologic and Clinical progression: * * * * * * * * *
More than 9 T2 lesions. Gadolinium enhancing lesions. Risk factors of Clinical progression: Cervical spine lesions. Infratentorial lesions. Pathologic VEP. High number of lesions. Younger age. O.C.B and/or IgG index with 9 T2 lesions.
331
discomfort, dyspnea, orthopnea and palpitation. On physical examination, the patient was in respiratory distress associated with tachycardia of 115/min, BP was 130\90, afebrile. Cardiac examination showed normal S1 an S2 heart sounds, with no murmurs, no JVP distention noted. However, the respiratory examination revealed fine basal lung crepitation bilaterally as well as bilateral lower edema in keeping with pulmonary edema. Neurological exam was stable. ECG showed sinus tachycardia and elevated ST segment elevation in all leads. Her echocardiogram was highly suggestive of acute myocarditis with reduced left ventricular ejection fraction (EF 30%) and pericardial effusion suggestive of associated pericarditis. She had a raised troponin level. Her relevant lab investigations to reveal a possible cause of myocarditis and pericarditis such as infectious and vasculitis workup all came back negative. Patient was treated in the cardiac critical unit (CCU) and her condition stabilized after 10 days with bed rest, anticoagulation, anti-platelets, diuretics and ACE inhibitor. A repeated ECG upon discharge was normal, and a follow up echocardiogram 3 weeks later showed marked improvement with normal left ventricular ejection fraction (EF 45%). This serious adverse effect has already been reported in cases other than Multiple Sclerosis which were treated with the same medication. But only few cases reported in MS patients which mandates strict monitoring at baseline and on regular basis. doi:10.1016/j.jns.2019.10.1450
WCN19-2138 Journal of the Neurological Sciences 405S (2019) 105112 Poster Session 3 Transorbital ultrasound in acute optic neuritis
DMT shows efficacy in brain atrophy patients.Thoracic spine lesions are advised to have DMT.Some suggest 6-months MRI followup;if dissemination in time proved Radiologically;DMT should be initiated at those of predictive findings in CSF(newly defined including IL-8 and chitinase 3-like-1 protein). doi:10.1016/j.jns.2019.10.1449
WCN19-2141 Journal of the Neurological Sciences 405S (2019) 105111 Poster Session 3 Alemtuzumab induced myocarditis and myocardial dysfunction in a patient with multiple sclerosis: A case report a
b
b
c
B. Mohamed , I. Alsharoqi , R. Matar , F. Almosawi a Salmanya Medical complex, Neuroscienence department, Manama, Bahrain b Salmanya Medical complex, Neuroscience department, Manama, Bahrain c Salmanya medical complex, Family Medicine department, Manama, Bahrain Two months after administering the first cycle of Alemtuzumab IV infusion at a dose of 12 mg\d for 5 days for MS treatment, a 28year-old female presented with 1-day history of sudden severe chest
Y.H. Kim Hangang Sacred Heart Hospital, Department of neurology, Seoul, Republic of Korea Introduction Visual evoked potentials (VEP), optical coherence tomography (OCT), and the magnetic resonance imaging have been used to evaluate functional and morphologic status of the afferent visual pathway, however these utilities have some limitation to evaluate optic nerve pathology in early stage. Recently transorbital ultrasound (TOUS) has been introduced as a promising tool to evaluate optic bulb and nerve. Objective To assess the practical diagnostic value of TOUS in patients with ON along with other diagnostic tools such as VEP, and OCT. Methods TOUS, OCT, and VEP were performed in both eyes of 8 patients with acute ON. The optic nerve were scanned bilaterally in transorbital view to obtain axial image. The optic nerve diameter was measured at point 3 mm posterior to eye globe with and without nerve sheath. All measured parameters were compared between affected and non-affected side. Results Eight patients (4 men, median age 43.5 years) were recruited. The median diameter of the optic nerve without sheath on the affected side (median 3.28 mm) was significantly larger compare to the nonaffected side (median 3.08 mm; p = .003). The diameter with sheath