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Journal of PRACTICAL NEUROLOGY Letters
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Incidental findings on MRI and unexpected multiple sclerosis
- Nitin K Sethi, Prahlad Sethi, Josh Torgovnick, and Edward Arsura (8 February 2008)
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Nitin K Sethi, MD NYP-Weill Cornell Medical Center, New York, NY, Prahlad Sethi, Josh Torgovnick, and Edward Arsura
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sethinitinmd{at}hotmail.com Nitin K Sethi, et al.
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Dear Editor
We read with interest the editorial (1) commenting on the paper by Lebrun and colleagues (2). Lebrun and colleagues report a 5 year follow-up of the clinical and MRI findings in patients with subclinical demyelinating lesions fulfilling Barkhof’s criteria on first MRI scan with a normal neurological examination at presentation. None of the 30 patients reported by them had presenting symptoms suggestive of multiple sclerosis and the index MRI was performed for causes which included headaches, migraine with or without aura, depression, dysmenorrhoea, craniocerebral trauma, epilepsy and cognitive changes. 72% of patients were found to have criteria of dissemination in space and time with a mean time of 2.3 years reported between the first MRI and clinically isolated syndrome (CIS). While this data does indeed shed new light on the preclinical history of CIS and MS, we feel it is heavily skewed by a selection and or referral bias. Majority of patients who present to a busy neurology outpatient department with headache, depression or even epilepsy and a normal neurological examination are found to have no intracranial pathology on neuroimaging. Finding demyelinating lesions fulfilling Barkhof’s criteria is the exception and not the rule though non-specific white matter hyperintensities on MRI (3) have been reported in migrainers. Ordering an MRI scan for migraine or dysmenorrhoea has the potential for generating data that the physician does not know how to interpret. This may compel both the patient and his physician to do something and the adage do not order a test if it is not going to alter the management may well hold good. Nitin K Sethi, Prahlad Sethi, Josh Torgovnick, Edward Arsura References 1. Chataway J. When the MRI scan suggests multiple sclerosis but the symptoms do not. J Neurol Neurosurg Psychiatry.2008 Feb; 79(2):112-3. 2.Lebrun C, Bensa C, Debouverie M, De Seze J, Wiertlievski S, Brochet B, Clavelou P, Brassat D, Labauge P, Roullet E. Unexpected multiple sclerosis: follow up of 30 patients with magnetic resonance imaging and clinical conversion profile. J Neurol Neurosurg Psychiatry.2008 Feb; 79(2):195-8. 3. Porter A, Gladstone JP, Dodick DW. Migraine and white matter hyperintensities. Curr Pain Headache Rep.2005 Aug; 9(4):289-93. Competing Interests: None declared |
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