MRI topography of lesions related to internuclear ophthalmoplegia in patients with multiple sclerosis or ischemic stroke.
Adult
Aged
Brain Ischemia
/ diagnostic imaging
Brain Stem
/ pathology
Female
Humans
Ischemic Stroke
/ diagnostic imaging
Magnetic Resonance Imaging
/ methods
Male
Mesencephalon
/ pathology
Middle Aged
Multiple Sclerosis
/ diagnostic imaging
Ocular Motility Disorders
/ diagnostic imaging
Pons
/ pathology
Retrospective Studies
INO
MRI
internuclear ophthalmoplegia
multiple sclerosis
stroke
Journal
Journal of neuroimaging : official journal of the American Society of Neuroimaging
ISSN: 1552-6569
Titre abrégé: J Neuroimaging
Pays: United States
ID NLM: 9102705
Informations de publication
Date de publication:
05 2021
05 2021
Historique:
revised:
11
02
2021
received:
22
01
2021
accepted:
15
02
2021
pubmed:
2
4
2021
medline:
15
7
2021
entrez:
1
4
2021
Statut:
ppublish
Résumé
Internuclear ophthalmoplegia is a dysfunction of conjugate eye movements, caused by lesions affecting the medial longitudinal fasciculus (MLF). Multiple sclerosis (MS) and ischemic stroke represent the most common pathophysiologies. While magnetic resonance imaging (MRI) allows for localizing lesions affecting the MLF, comprehensive comparative studies exploring potential different spatial characteristics of lesions affecting the MLF are missing until now. We retrospectively investigated MRI examinations of 82 patients (40 patients with MS and 42 patients with ischemic stroke). For lesion localization, the brainstem was segmented into (1) ponto-medullary junction, (2) mid pons, (3) upper pons, and (4) mesencephalon. Corresponding lesions affecting the MLF were observed in 29/40 (72.5%) MS and 38/42 (90.5%) stroke patients. Compared to stroke patients, MS patients had significantly more lesions in multiple locations (P < .001). Stroke patients showed more lesions at the level of the mesencephalon (P < .001), while lesions at the level of the ponto-medullary junction, mid, and upper pons did not statistically differ between the groups. Our results demonstrate that multiple lesions affecting the MLF make inflammatory-demyelination due to MS more likely, while lesion localization at the level of the mesencephalon favors ischemia.
Sections du résumé
BACKGROUND AND PURPOSE
Internuclear ophthalmoplegia is a dysfunction of conjugate eye movements, caused by lesions affecting the medial longitudinal fasciculus (MLF). Multiple sclerosis (MS) and ischemic stroke represent the most common pathophysiologies. While magnetic resonance imaging (MRI) allows for localizing lesions affecting the MLF, comprehensive comparative studies exploring potential different spatial characteristics of lesions affecting the MLF are missing until now.
METHODS
We retrospectively investigated MRI examinations of 82 patients (40 patients with MS and 42 patients with ischemic stroke). For lesion localization, the brainstem was segmented into (1) ponto-medullary junction, (2) mid pons, (3) upper pons, and (4) mesencephalon.
RESULTS
Corresponding lesions affecting the MLF were observed in 29/40 (72.5%) MS and 38/42 (90.5%) stroke patients. Compared to stroke patients, MS patients had significantly more lesions in multiple locations (P < .001). Stroke patients showed more lesions at the level of the mesencephalon (P < .001), while lesions at the level of the ponto-medullary junction, mid, and upper pons did not statistically differ between the groups.
CONCLUSION
Our results demonstrate that multiple lesions affecting the MLF make inflammatory-demyelination due to MS more likely, while lesion localization at the level of the mesencephalon favors ischemia.
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
471-474Informations de copyright
© 2021 The Authors. Journal of Neuroimaging published by Wiley Periodicals LLC on behalf of American Society of Neuroimaging.
Références
Frohman TC, Galetta S, Fox R, et al. Pearls & Oy-sters: the medial longitudinal fasciculus in ocular motor physiology. Neurology 2008;70:e57-67.
Eggenberger E, Golnik K, Lee A, et al. Prognosis of ischemic internuclear ophthalmoplegia. Ophthalmology 2002;109:1676-8.
Sakaie K, Takahashi M, Sagiyama K, et al. Injury to a specific neural pathway detected by ultra-high-field MRI. Neurology 2014;82:182-3.
Frohman EM, Zhang H, Kramer PD, et al. MRI characteristics of the MLF in MS patients with chronic internuclear ophthalmoparesis. Neurology 2001;57:762-8.
Wang C, Paling D, Chen L, et al. Axonal conduction in multiple sclerosis: a combined magnetic resonance imaging and electrophysiological study of the medial longitudinal fasciculus. Mult Scler 2015;21:905-15.
Kim JS. Internuclear ophthalmoplegia as an isolated or predominant symptom of brainstem infarction. Neurology 2004;62:1491-6.
Mawad ME, Silver AJ, Hilal SK, et al. Computed tomography of the brain stem with intrathecal metrizamide. Part I: the normal brain stem. AJR Am J Roentgenol 1983;140:553-63.
Haines DE. Internal morphology of the brain in unstained slices and MRI. Part II: brain slices in the axial plane correlated with MRI. In: Haines DE, ed. Neuroanatomy: An Atlas of Structures, Sections, and Systems. 8th ed. Baltimore, MD: Lippincott Williams & Wilkins; 2012:84-91.
Muri RM, Meienberg O. The clinical spectrum of internuclear ophthalmoplegia in multiple sclerosis. Arch Neurol 1985;42:851-5.
Bolanos I, Lozano D, Cantu C. Internuclear ophthalmoplegia: causes and long-term follow-up in 65 patients. Acta Neurol Scand 2004;110:161-5.
Karatas M. Internuclear and supranuclear disorders of eye movements: clinical features and causes. Eur J Neurol 2009;16:1265-77.
McNulty JP, Lonergan R, Bannigan J, et al. Visualisation of the medial longitudinal fasciculus using fibre tractography in multiple sclerosis patients with internuclear ophthalmoplegia. Ir J Med Sci 2016;185:393-402.
Bogousslavsky J, Van Melle G, Regli F. The Lausanne Stroke Registry: analysis of 1,000 consecutive patients with first stroke. Stroke 1988;19:1083-92.
Ortiz de Mendivil A, Alcala-Galiano A, Ochoa M, et al. Brainstem stroke: anatomy, clinical and radiological findings. Semin Ultrasound CT MR 2013;34:131-41.
Miller D, Barkhof F, Montalban X, et al. Clinically isolated syndromes suggestive of multiple sclerosis, part I: natural history, pathogenesis, diagnosis, and prognosis. Lancet Neurol 2005;4:281-8.
Atlas SW, Grossman RI, Savino PJ, et al. Internuclear ophthalmoplegia: MR-anatomic correlation. AJNR Am J Neuroradiol 1987;8:243-7.
Sakaie K, Takahashi M, Dimitrov I, et al. Diffusion tensor imaging the medial longitudinal fasciculus in INO: opportunities and challenges. Ann N Y Acad Sci 2011;1233:307-12.