RESUMEN
Cortical lesions (CLs) detected with double inversion recovery (DIR) magnetic resonance imaging (MRI) are very helpful in differentiating multiple sclerosis (MS) from other neuroinflammatory diseases of the central nervous system (CNS), that is, neuromyelitis optica spectrum disorders (NMOSDs). Furthermore, CLs are closely related to motor and cognitive impairment. We report a case of a 48-year-old female MS patient who developed several CLs during anti-CD20 therapy. Some CLs disappeared during follow-up MRIs. In the suspicion of a treatment failure, the screening for the autologous hematopoietic stem cell transplant (AHSCT) was performed with the evidence of an atrial myxoma. In MS patients with new CLs, a comorbid ischemic pathology should be considered and carefully investigated.
Asunto(s)
Fibrilación Atrial , Esclerosis Múltiple , Mixoma , Neuromielitis Óptica , Femenino , Humanos , Persona de Mediana Edad , Fibrilación Atrial/patología , Corteza Cerebral/patología , Esclerosis Múltiple/patología , Neuromielitis Óptica/patología , Imagen por Resonancia Magnética/métodos , Mixoma/diagnóstico por imagen , Mixoma/patologíaAsunto(s)
Rinorrea de Líquido Cefalorraquídeo/diagnóstico por imagen , Hipotensión Intracraneal/etiología , Mielografía/métodos , Neurofibroma/cirugía , Procedimientos Neuroquirúrgicos/efectos adversos , Neoplasias de la Médula Espinal/cirugía , Tomografía Computarizada por Rayos X , Rinorrea de Líquido Cefalorraquídeo/complicaciones , Rinorrea de Líquido Cefalorraquídeo/etiología , Humanos , Procesamiento de Imagen Asistido por Computador , Hipotensión Intracraneal/fisiopatología , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Neurofibroma/diagnóstico , Neoplasias de la Médula Espinal/diagnósticoRESUMEN
The aim of this paper is to present a sequential protocol to be used in clinical practice for the detection of liver diseases, based on clinical history, physical examination, and laboratory investigation. The evaluation of the protocol efficacy was carried out on a sample of 288 subjects (92 normal, and 196 affected by various liver alterations) by comparing the obtained results with reference classifications independently performed on the basis of all available subject records (including many more laboratory tests than the ones used in the protocol). A cost-benefit analysis was also carried out, based on the resident population of Regione Piemonte, comparing the protocol with two other simpler ones. Results show that the proposed protocol allows a considerable reduction of costs, showing a high estimated efficacy for clinical use.