Breakdown of the blood-brain barrier precedes symptoms and other MRI signs of new lesions in multiple sclerosis. Pathogenetic and clinical implications.
From an extensive serial magnetic resonance imaging (MRI) study in multiple sclerosis (MS) we have identified 4 cases in which disruption of the blood-brain barrier, as detected by gadolinium-DTPA enhancement, preceded other MRI abnormalities and in 1 case clinical evidence of the new lesion. This supports the view that a defect in the blood-brain barrier, and therefore inflammation, is an early and possibly crucial event in the pathogenesis of the new lesion in MS. These cases showed a marked discrepancy between MRI abnormality and symptoms. The mechanisms contributing to this disparity are discussed, and it is concluded that far from being surprising it is to be expected.
Kermode
A G
AG
Multiple Sclerosis NMR Research Group, Institute of Neurology, London, UK.
Thompson
A J
AJ
Tofts
P
P
MacManus
D G
DG
Kendall
B E
BE
Kingsley
D P
DP
Moseley
I F
IF
Rudge
P
P
McDonald
W I
WI
D000328:Adult; D001812:Blood-Brain Barrier; D001921:Brain / Q000473:pathology; D003287:Contrast Media; D004185:Disability Evaluation; D005260:Female; D019786:Gadolinium DTPA; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000175:diagnosis / Q000378:metabolism* / Q000503:physiopathology; D009942:Organometallic Compounds; D004369:Pentetic Acid
D003287:Contrast Media; D009942:Organometallic Compounds; D004369:Pentetic Acid; D019786:Gadolinium DTPA