RESUMEN
Tumefactive demyelinating lesions are rare consequences of central nervous system (CNS) idiopathic inflammatory demyelinating diseases. Tumefactive demyelinating lesions pose a diagnostic challenge because they can mimic tumors and abscesses and because they can be caused by a heterogeneous range of disorders. This article reviews the recent literature on the clinical presentation; radiographic features; prognosis; and management of tumefactive demyelinating lesions in multiple sclerosis, acute demyelinating encephalomyelitis, neuromyelitis optica, and the rare variants of multiple sclerosis including Schilder's disease, Marburg acute multiple sclerosis, and Balo's concentric sclerosis.
Asunto(s)
Esclerosis Múltiple/diagnóstico por imagen , Esclerosis Múltiple/patología , Biopsia , Encéfalo/patología , Humanos , Esclerosis Múltiple/epidemiología , Esclerosis Múltiple/terapia , Pronóstico , RadiografíaRESUMEN
Japanese macaque encephalomyelitis (JME) is an inflammatory demyelinating disease that occurs spontaneously in a colony of Japanese macaques (JM) at the Oregon National Primate Research Center. Animals with JME display clinical signs resembling multiple sclerosis (MS), and magnetic resonance imaging reveals multiple T2-weighted hyperintensities and gadolinium-enhancing lesions in the central nervous system (CNS). Here we undertook studies to determine if JME possesses features of an immune-mediated disease in the CNS. Comparable to MS, the CNS of animals with JME contain active lesions positive for IL-17, CD4+ T cells with Th1 and Th17 phenotypes, CD8+ T cells, and positive CSF findings.
Asunto(s)
Sistema Nervioso Central/patología , Encefalomielitis/embriología , Encefalomielitis/patología , Esclerosis Múltiple/inmunología , Esclerosis Múltiple/patología , Animales , Antígenos CD/metabolismo , Linfocitos B/metabolismo , Linfocitos B/patología , Citocinas/metabolismo , Modelos Animales de Enfermedad , Linfocitos/metabolismo , Linfocitos/patología , Macaca , Macrófagos/metabolismo , Macrófagos/patología , Imagen por Resonancia Magnética , Proteínas de Microfilamentos/metabolismo , Microglía/metabolismo , Microglía/patología , Proteína Básica de Mielina/metabolismo , Proteínas del Tejido Nervioso/metabolismoRESUMEN
We reviewed records of patients seen in a tertiary Neurobehavior Clinic to identify those who had community-acquired PET scans as part of their dementia diagnostic evaluation with the goal of assessing factors influencing diagnostic accuracy. We compared outside radiologist PET diagnoses to our consensus clinical diagnosis and collected data regarding clinical variables, ordering reasons, and specialties of interpreting and ordering physicians. Among 1,580 total patients seen in our clinic, 46 met our inclusion criteria. There was disagreement between outside diagnosis based on PET and our consensus diagnosis in 65% (n = 30) of patients. Community-acquired PET scans may have lower diagnostic value in dementia evaluation than suggested by prior research and may be associated with significant risks including misdiagnosis with an incurable neurodegenerative disease.