Concurrence Of Multiple Sclerosis Research Articles

Concurrence of Multiple Sclerosis, Oligodendroglioma, and Autosomal Recessive Cerebellar Ataxia with Spasticity in the Same Patient: A Challenging Diagnosis

Multiple sclerosis (MS) has been described in several case reports to coexist with brain tumors. This unusual concurrence has been grabbing attention to whether these pathological entities share common roots. However, no clear association has proved that either of them could provoke the other, and mere chance is the only acceptable explanation. Along all reported cases, oligodendroglioma has been rarely reported to co-occur with MS. In this paper, we report a unique case with a triad of MS, oligodendroglioma, and autosomal recessive cerebellar ataxia with spasticity and discuss possible theories that might have attributed to these three conditions. To our knowledge, this is the first case ever to have these three conditions present in one patient. The most likely explanation is believed to be that this patient was unfortunate to have three unrelated diseases.

Red Ear Syndrome preceding Multiple Sclerosis: A Novel Correlation

Red Ear Syndrome (RES) is a rare condition, first described in 1994 by Lance. It is characterized by burning pain, warmth, and erythema of the auricle. Here, we report the case of a young woman who manifested symptoms of red ear syndrome 3 years prior to those of multiple sclerosis (MS). She also had a history of episodic infrequent migraine and anxiety disorder. Association of Multiple Sclerosis (MS) with Red Ear Syndrome is hitherto unreported. We propose the involvement of Neuropeptide Y (NPY), or a dysfunction thereof, as the underlying pathophysiological mechanism to explain the concurrence of MS and RES, along with other presenting co-morbidities.

Concurrence of multiple sclerosis and brain tumors.

Multiple sclerosis (MS) is a chronic demyelinating inflammatory disease of the central nervous system (CNS) with multi-factorial pathogenesis that includes genetic and environmental factors. A primary brain tumor is a neoplasm developing from the cells of the brain. There is high heterogeneity of primary brain tumors (about 100 different types); however, most of them develop from the glial cells. Although several types of brain tumors have been widely described in association with MS (1–20), including astrocytoma (5, 9), oligodendroglioma (12, 17), and glioblastoma (3, 11, 14, 18), it is not clear whether their occurrence is accidental or consequent to causal events. Moreover, it is not completely defined if MS and brain tumors, when associated, have a different course. The true incidence of brain tumors in MS patients is difficult to define because the diagnosis of a brain tumor in MS patients may seem more frequent than in the general population due to frequent neuroimaging scans performed in these patients (21). At the same time, pseudo-tumoral MS lesions may resemble gliomas, and conversely, early stage gliomas may resemble MS. Brain tumors in MS patients may be diagnosed later or even post-mortem (22), especially in patients with progressive MS, since the new symptoms may be attributed to the gradual clinical progression of MS rather than to the slow growing of tumor itself (23). A recent study reported that MS patients have a decreased overall cancer risk, but an increased risk for brain tumor (24). If immunosuppressive treatment for MS might promote cancerogenesis is still matter of debate, it is difficult to explain on this basis why MS patients have a decreased overall cancer risk and an increased risk only for brain and genitourinary tract tumors (24). A successive systematic analysis showed no increased or decreased risks for glioma in MS patients, while an increased risk was found for meningioma, as a result of incidental findings (25). Moreover, several autoimmune diseases influence negatively the survival in glioma and meningioma, likely due to pre-existent disability or treatment limitations (25).

Neuroendocrine cell carcinoma of unknown primary arising in long standing history of multiple sclerosis.

Multiple sclerosis (MS) is a chronic autoimmune disease that targets myelinated axons in the central nervous system (CNS). Cancer of unknown primary site (CUP) is a well-recognised clinical disorder, accounting for 3–5% of all malignant epithelial tumors. CUP is clinically characterised as an aggressive disease with early dissemination. Studies of cancer risk in MS patients have shown inconsistent findings. An increased risk of malignancy in patients with MS has been suggested, but recently serious questions have been raised regarding this association. Use of disease-modifying therapies might contribute to an increased cancer risk in selected MS patients. The concurrence of MS and CUP is exceptionally rare. Here we describe the case of a neuroendocrine carcinoma of unknown primary diagnosed in a male patient with a nine-year history of MS. The discussion includes data from all available population-based register studies with estimates of certain malignancies in patients with MS.

Cooccurrence of Multiple Sclerosis and Idiopathic Basal Ganglia Calcification

Multiple sclerosis (MS) is a chronic inflammatory demyelinating and neurodegenerative disease of central nervous system that affects both white and gray matter. Idiopathic calcification of the basal ganglia is a rare neurodegenerative disorder of unknown cause that is characterized by sporadic or familial brain calcification. Concurrence of multiple sclerosis (MS) and idiopathic basal ganglia calcification (Fahr's disease) is very rare event. In this study, we describe a cooccurrence of idiopathic basal ganglia calcification with multiple sclerosis. The association between this disease and MS is unclear and also maybe probably coincidental.

ED-22 * CONCURRENCE OF GLIOMAS IN PATIENTS WITH MULTIPLE SCLEROSIS: CASE REPORT AND LITERATURE REVIEW

The concurrence of multiple sclerosis (MS) and gliomas is rare. Even though new symptoms in MS patients are likely due to disease progression, here we report a case demonstrating the importance of thorough clinical and radiologic evaluation and maintaining an open differential when investigating these new complaints. CASE REPORT: 79 year old man with MS diagnosed in 1980 managed on interferon-beta prior to 2009 complained of rapidly progressive cognitive decline in 12/2013 that began 3 months prior. Neurologic examination in 04/2014 revealed significant deterioration in memory and attention, worsened generalized weakness and ataxia, and the presence of aphasia, acalculia, and a left homonymous hemianopsia. A subsequent MRI brain with contrast showed a new extensive, infiltrative mass extending from the right parietoccipital region across a markedly expanded corpus callosum. CSF analysis demonstrated elevated protein, normal cell count, and negative EBV/ JC virus PCR and cytology. Pathology from a stereotactic biopsy confirmed the diagnosis of anaplastic glioma. The family declined further intervention and the patient died five days later in hospice. DISCUSSION: While MS complaints are broad and progressive, attributing all new, especially rapidly progressive, symptoms to MS should be cautioned. This case demonstrates the rare concurrence of MS and glioma. Limited data and epidemiology studies suggest that MS patients are not predisposed to primary brain tumors and coexistence of these entities does not influence the evolution of either disease. Data of long-term effects of immunomodulators used in the management of MS suggests no increased cancer risk. The most common brain tumors reported in MS patients include; oligodendroglioma, astrocytoma, glioblastoma, and gliomatosis cerebri. It is postulated that chronic inflammation in MS plaques induces neoplastic transformation of glial cells. However, contiguity between tumor and potentially neoplastic astrocytes within plaques is not always present. Additional research may determine the presence of any causal relationships.

69.: Neuropathological, imaging and clinical features of a patient with neurofibromatosis type 1 and multiple sclerosis

We present detailed histopathological and clinical characterisation of a young male patient with neurofibromatosis type 1 (NF1) and primary progressive multiple sclerosis (MS) and discuss the putative basis for association between these diseases. A young man with typical cutaneous stigmata of NF1 presented in his late 20s with a progressive myelopathy and pancerebellar disturbance. MRI demonstrated multifocal T2-weighted hyperintensities in the hemispheres, brainstem and spinal cord. Investigations revealed cerebrospinal fluid oligoclonal immunoglobulin G bands, and absent visual evoked responses. Clinical progression was rapid and non-remitting. Within 4 years he was wheelchair-bound. He died following an aspiration event 6 years after presentation. Histopathologically, extensive multifocal, and sometimes confluent, areas of demyelination were seen with perivascular inflammation and astrogliosis in the hemispheres and spinal cord. Abundant corpora amylacea deposition in areas of white matter degeneration was present. NF1 is an autosomal dominant neurocutaneous disorder caused by mutation in the Neurofibronin gene. It is unclear if the concurrence of MS and NF1 occurs by chance but early hypotheses of causal associations followed the discovery that the oligodendrocyte myelin glycoprotein gene is embedded within the NF1 gene. Approximately 27 patients with MS and NF1 have been described but none with detailed neuropathologic data, to our knowledge. In this patient, the rapidly progressive phenotype, severity of tissue injury histopathologically and extensive presence of corpora amylacea are of interest. Clinicians should be vigilant for the development of central nervous system demyelinating disease in patients with NF1.

Multiple sclerosis presents with psychotic symptoms and coexists with hypertrophic cardiomyopathy.

Multiple sclerosis (MS) is a demyelinating disease of the central nervous system. Psychiatric symptoms are not infrequent during MS, yet onset of MS with psychosis is rarely encountered. A 27-year-old Caucasian male was admitted due to numbness in his right arm and difficulty in walking. His clinical and laboratorial exams lead to the MS diagnosis. Nine months earlier, he also developed psychotic disorder, not otherwise specified (PD-NOS). His sudden onset of PD-NOS, his rapid and complete response to antipsychotics, and a relatively short interval between psychiatric and neurological signs indicate a high likelihood that PD-NOS was a manifestation of underlying MS. He also suffers from hypertrophic obstructive cardiomyopathy (HOCM). The patient's neurological complaints were recovered with methylprednisolone (1 g/day, i.v.) given for five days. Glatiramer acetate (1 × 1 tb.s.c.) was prescribed for consolidation and, after nine months of his admission, the patient fully recovered from neurological and psychiatric complaints. Interestingly, very recent studies indicate specific alpha-actinin antibodies in MS and alpha-actinin mutations cause HOCM. Thus, concurrence of MS with HOCM can be even a new syndrome, if further genetic studies prove.

Concurrence of multiple sclerosis and amyotrophic lateral sclerosis in patients with hexanucleotide repeat expansions of C9ORF72

BackgroundCrossover in the pathogenic mechanisms of amyotrophic lateral sclerosis (ALS) and multiple sclerosis (MS) has been described but is poorly understood. A GGGGCC hexanucleotide repeat expansion of C9ORF72 has recently...

Concurrence of Juvenile Idiopathic Arthritis and Multiple Sclerosis

We report a 21-year-old female patient known to have Juvenile idiopathic arthritis (JIA) who later developed multiple sclerosis (MS). The disease was documented on the brain and cerebral magnetic resonance imaging (MRI) and the visual evoked potential. Our case emphasizes the need to evaluate the symptoms and brain MRI carefully. The concurrence of MS and JIA is uncommon. The possible relationship between the 2 diseases was discussed.

Anaplastic oligodendroglioma and gliomatosis type 2 in interferon-β treated multiple sclerosis patients: Report of two cases

The concurrence of multiple sclerosis (MS) and brain tumors has been reported, but it is not known whether MS patients are at greater risk of harbouring the latter. The most common cerebral neoplasms reported in MS patients were oligodendroglioma, astrocytoma, glioblastoma and gliomatosis. MS can also present as a mass lesion that mimics a brain tumor. To establish the correct diagnosis radiological follow-up and/or histological confirmation is needed. Two cases of coincidental MS and brain tumors are reviewed. One is a 26-year-old woman with relapsing–remitting MS and an anaplastic oligodendroglioma, the other a 49-year-old woman patient with relapsing–remitting MS and gliomatosis type 2. Both patients were treated with interferon-β1b and both died from the tumor. The concurrence of MS and brain tumors could be purely coincidental, or the result of neoplastic transformation of reactive glial cells in the areas of demyelination. The combination of a brain tumor and MS, and interferon-β treatment could also be pure coincidence or an unknown side effect of treatment. Although interferon-β has been said to function as a tumor-suppressor protein, the influence of long-term treatment of MS patients on cancer development is not known.

Oligodendroglioma and multiple sclerosis. A case report

The concurrence of multiple sclerosis (MS) and glioma is uncommon. Approximately 30 cases have been reported, but in only six of them the tumour was pure or mixed oligodendroglioma. The appearance of new neurological symptoms and signs in a patient with multiple sclerosis is usually attributed to a relapse of this disease and neuroradiological studies are not always performed. When done, the finding of a new focal mass lesion is usually interpreted as a pseudotumoural plaque. A 37-year-old man was admitted because of partial simple seizures and an enlarging intracranial mass. He had been diagnosed of MS eleven years earlier. A MRI study performed eight years before admission showed a large mass in the right frontal lobe which was thought to be a pseudotumoural plaque. Two years later, he developed simple partial motor seizures that were initially controlled with valproic acid. He remained well until three months before admission, when seizures reappeared with a poor response to valproic acid. A new MRI study showed an heterogeneous right frontal enlarging mass lesion. A primary neoplasm was suspected and a subtotal removal was performed. The pathological diagnosis was oligodendroglioma with a periferic demyelinating area. Atypical MRI lesions in a patient with MS must be carefully interpreted. Pseudotumoural plaques have been described both clinically and radiologically to be hardly distinguishable from a tumoural lesion and histological confirmation is often required. The association between MS and glioma is uncommon but it must be kept in mind when a mass lesion develops in a patient with MS.

Brain white-matter lesions in inflammatory bowel disease

Geissler et al 1 Geissler A Andus T Roth M et al. Focal white-matter lesions in brain of patients with inflammatory bowel disease. Lancet. 1995; 345: 897-898 Crossref PubMed Scopus (110) Google Scholar reported that 42% of patients with Crohn's disease (CD) and 46% with ulcerative colitis (UC) have small white-matter lesions (WML) on magnetic resonance imaging (MRI) brain scans. These changes were found in only 16% of healthy controls. The authors suggested that these abnormalities might be of ischaemic origin, secondary to atherosclerosis or vasculitis. The possibility of demyelination has also been raised. 2 Agranoff D Schon F Are focal white matter lesions in patients with inflammatory bowel disease linked to multiple sclerosis?. Lancet. 1995; 346: 190 Abstract PubMed Google Scholar Their study was a neuroradiological one without any evaluation of whether the patients with WML had any neurological symptoms or signs. Neurological complications of inflammatory bowel disease are rare. The largest study of 638 patients reported an incidence of 3% of which 47% involved the central nervous system. 3 Lossos A River Y Eliamkim A Steiner I Neurologic aspects of inflammatory bowel disease. Neurology. 1995; 45: 416 Crossref PubMed Scopus (200) Google Scholar Evidence also exists for an association between inflammatory bowel disease (IBD) and multiple sclerosis. 4 Sadovnick AD Paty DW Yannakoulias G Concurrence of multiple sclerosis and inflammatory bowel disease. N Engl J Med. 1989; 321: 762-763 PubMed Google Scholar We set out to repeat the study and, in particular to assess the patients' neurological status.

Concurrence of multiple sclerosis and Hodgkin's disease

Although multiple sclerosis and Hodgkin's disease are reported to have similar epidemiologic features, this is only the first case report in which there was concurrence of these diseases. Fourteen years after successful treatment of Hodgkin's disease, this 31-year-old white male developed multiple sclerosis. The diagnosis of multiple sclerosis was made on the basis of clinical and paraclinical findings that were characteristic of multiple sclerosis. In addition, specific tests were performed to rule out a variety of infectious, metabolic, and neoplastic diseases that simulate multiple sclerosis.

The Concurrence of Multiple Sclerosis and Amyotrophic Lateral Sclerosis

We report the clinical and pathological findings of the unusual combination of two idiopathic central nervous system diseases, multiple sclerosis and amyotrophic lateral sclerosis in a 56 year old physician with a twenty-seven year history of a disease initially characterized by relapses and remissions, followed by an eight year quiescent period. During the last year of life there was rapid deterioration with development of generalized weakness, atrophy, weight loss and fasciculations of body and tongue, and associated difficulty with swallowing and sudden respiratory failure. The autopsy confirmed characteristic "burned out" plaques of multiple sclerosis and anterior horn cell and axonal degeneration of amyotrophic lateral sclerosis.

Concurrence of multiple sclerosis and glioma.

Three cases are reported of concurrence of malignant gliomas (astrocytomas and glioblastomas) with multiple sclerosis (MS). This situation may lead to considerable diagnostic difficulties, yet an accurate appraisal is of prognostic, if not therapeutic, value. There is suggestive but inconclusive evidence that the two conditions may be causally related, malignant astrocytic tumours arising from plaques of MS. The small number of reported cases makes statistical analysis impossible, but the scanty literature may not reflect the true incidence.