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Article: Brain involvement in neuromyelitis optica spectrum disorders

TitleBrain involvement in neuromyelitis optica spectrum disorders
Authors
Issue Date2011
PublisherAmerican Medical Association. The Journal's web site is located at http://www.archneurol.com
Citation
Archives Of Neurology, 2011, v. 68 n. 11, p. 1432-1439 How to Cite?
AbstractBackground: Neuromyelitis optica spectrum disorders (NMOSDs) are severe inflammatory demyelinating disorders of the central nervous system. Brain involvement is increasingly recognized. Objective: To study brain involvement in NMOSDs among Hong Kong Chinese patients. Design: Retrospective study of patients with NMOSDs. Setting: Tertiary medical center in Hong Kong. Patients: Thirty-four Hong Kong Chinese patients with NMOSDs of 2 years or longer were recruited. Interventions: Brain and spinal cord magnetic resonance imaging was performed duringNMOSDattacks and was repeated yearly for the first 3 years. Main Outcome Measures: We evaluated clinical features of NMOSDs associated with brain involvement and brain lesions on magnetic resonance imaging. Results: Among 34 patients with NMOSDs of 2 years or longer, 20 (59%) had brain involvement. The mean age at onset among these 20 patients was 45.6 years (age range, 19-67 years); 18 were women. Eleven patients (32% of all the patients with NMOSDs) had clinical manifestation of brain involvement, 19 patients (56%) had brain abnormalities on magnetic resonance imaging consistent with inflammatory demyelination, and 2 patients (6%) fulfilled criteria for multiple sclerosis. Clinical manifestation of brain involvement included the following: trigeminal neuralgia; vomiting, vertigo, ataxia, dysphagia, and tetraparesis from lesions around the third and fourth ventricles and aqueduct; homonymous hemianopia, aphasia, hemiparesis, and cognitive impairment from extensive hemispheric white matter lesions; and ataxia, diplopia, hiccups, facial sensory loss, internuclear ophthalmoplegia, hemisensory loss, and hemiparesis from other lesions in the midbrain, pons, cerebellar peduncles, and medulla. Eight patients (24%) developed brainstem encephalitis clinically, and brainstem encephalitis was the initial clinical manifestation in 6 patients (18%). Brain abnormalities on magnetic resonance imaging were detected in brainstem in 15 patients (44%), hemispheric periventricular white matter in 7 patients (21%), deep white matter in 7 patients (21%), corpus callosum in 4 patients (12%), subcortical white matter in 3 patients (9%), thalamus in 2 patients (6%), hypothalamus in 1 patient (3%), basal ganglia in 1 patient (3%), internal capsule in 1 patient (3%), periaqueductal gray matter in 1 patient (3%), and around the third and fourth ventricles in 1 patient (3%); large confluent lesions were detected in 2 patients (6%). Conclusion: Brain involvement manifesting clinically as brainstem encephalitis is common among Hong Kong Chinese patients with NMOSDs. ©2011 American Medical Association. All rights reserved.
Persistent Identifierhttp://hdl.handle.net/10722/163416
ISSN
2014 Impact Factor: 7.419
References

 

DC FieldValueLanguage
dc.contributor.authorChan, KHen_US
dc.contributor.authorTse, CTen_US
dc.contributor.authorChung, CPen_US
dc.contributor.authorLee, RLCen_US
dc.contributor.authorKwan, JSCen_US
dc.contributor.authorHo, PWLen_US
dc.contributor.authorHo, JWMen_US
dc.date.accessioned2012-09-05T05:31:08Z-
dc.date.available2012-09-05T05:31:08Z-
dc.date.issued2011en_US
dc.identifier.citationArchives Of Neurology, 2011, v. 68 n. 11, p. 1432-1439en_US
dc.identifier.issn0003-9942en_US
dc.identifier.urihttp://hdl.handle.net/10722/163416-
dc.description.abstractBackground: Neuromyelitis optica spectrum disorders (NMOSDs) are severe inflammatory demyelinating disorders of the central nervous system. Brain involvement is increasingly recognized. Objective: To study brain involvement in NMOSDs among Hong Kong Chinese patients. Design: Retrospective study of patients with NMOSDs. Setting: Tertiary medical center in Hong Kong. Patients: Thirty-four Hong Kong Chinese patients with NMOSDs of 2 years or longer were recruited. Interventions: Brain and spinal cord magnetic resonance imaging was performed duringNMOSDattacks and was repeated yearly for the first 3 years. Main Outcome Measures: We evaluated clinical features of NMOSDs associated with brain involvement and brain lesions on magnetic resonance imaging. Results: Among 34 patients with NMOSDs of 2 years or longer, 20 (59%) had brain involvement. The mean age at onset among these 20 patients was 45.6 years (age range, 19-67 years); 18 were women. Eleven patients (32% of all the patients with NMOSDs) had clinical manifestation of brain involvement, 19 patients (56%) had brain abnormalities on magnetic resonance imaging consistent with inflammatory demyelination, and 2 patients (6%) fulfilled criteria for multiple sclerosis. Clinical manifestation of brain involvement included the following: trigeminal neuralgia; vomiting, vertigo, ataxia, dysphagia, and tetraparesis from lesions around the third and fourth ventricles and aqueduct; homonymous hemianopia, aphasia, hemiparesis, and cognitive impairment from extensive hemispheric white matter lesions; and ataxia, diplopia, hiccups, facial sensory loss, internuclear ophthalmoplegia, hemisensory loss, and hemiparesis from other lesions in the midbrain, pons, cerebellar peduncles, and medulla. Eight patients (24%) developed brainstem encephalitis clinically, and brainstem encephalitis was the initial clinical manifestation in 6 patients (18%). Brain abnormalities on magnetic resonance imaging were detected in brainstem in 15 patients (44%), hemispheric periventricular white matter in 7 patients (21%), deep white matter in 7 patients (21%), corpus callosum in 4 patients (12%), subcortical white matter in 3 patients (9%), thalamus in 2 patients (6%), hypothalamus in 1 patient (3%), basal ganglia in 1 patient (3%), internal capsule in 1 patient (3%), periaqueductal gray matter in 1 patient (3%), and around the third and fourth ventricles in 1 patient (3%); large confluent lesions were detected in 2 patients (6%). Conclusion: Brain involvement manifesting clinically as brainstem encephalitis is common among Hong Kong Chinese patients with NMOSDs. ©2011 American Medical Association. All rights reserved.en_US
dc.languageengen_US
dc.publisherAmerican Medical Association. The Journal's web site is located at http://www.archneurol.comen_US
dc.relation.ispartofArchives of Neurologyen_US
dc.subject.meshAdulten_US
dc.subject.meshAgeden_US
dc.subject.meshBrain - Pathologyen_US
dc.subject.meshFemaleen_US
dc.subject.meshHumansen_US
dc.subject.meshMaleen_US
dc.subject.meshMiddle Ageden_US
dc.subject.meshNeuromyelitis Optica - Classification - Pathologyen_US
dc.subject.meshRetrospective Studiesen_US
dc.subject.meshSpinal Cord - Pathologyen_US
dc.subject.meshYoung Adulten_US
dc.titleBrain involvement in neuromyelitis optica spectrum disordersen_US
dc.typeArticleen_US
dc.identifier.emailHo, PWL:hwl2002@hku.hken_US
dc.identifier.authorityHo, PWL=rp00259en_US
dc.description.naturelink_to_subscribed_fulltexten_US
dc.identifier.doi10.1001/archneurol.2011.249en_US
dc.identifier.pmid22084126-
dc.identifier.scopuseid_2-s2.0-81355133338en_US
dc.identifier.hkuros185126-
dc.relation.referenceshttp://www.scopus.com/mlt/select.url?eid=2-s2.0-81355133338&selection=ref&src=s&origin=recordpageen_US
dc.identifier.volume68en_US
dc.identifier.issue11en_US
dc.identifier.spage1432en_US
dc.identifier.epage1439en_US
dc.identifier.eissn2168-6157-
dc.publisher.placeUnited Statesen_US
dc.identifier.scopusauthoridChan, KH=7406034963en_US
dc.identifier.scopusauthoridTse, CT=50361920200en_US
dc.identifier.scopusauthoridChung, CP=15847941600en_US
dc.identifier.scopusauthoridLee, RLC=7408202795en_US
dc.identifier.scopusauthoridKwan, JSC=36479956300en_US
dc.identifier.scopusauthoridHo, PWL=25027612100en_US
dc.identifier.scopusauthoridHo, JWM=8685214100en_US

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