title: Unfolding the long-term pathophysiological processes following an acute inflammatory demyelinating lesion of multiple sclerosis.
abstract: BACKGROUND
  Acute symptomatic inflammation is a main feature of multiple sclerosis but pathophysiological processes underlying total or partial recovery are poorly understood.
  
  
  OBJECTIVE
  To characterize in vivo these processes at molecular, structural and functional levels using multimodal MR methods.
  
  
  METHODS
  A neuroimaging 3-year follow-up (Weeks 0, 3, 11, 29, 59 and 169) was conducted on a 41-year-old woman presenting at baseline with a large acute demyelinating lesion of multiple sclerosis. Conventional magnetic resonance imaging (MRI), magnetization transfer imaging, diffusion-weighted imaging, functional MRI and magnetic resonance spectroscopy were conducted at 1.5 T.
  
  
  RESULTS
  Patient presenting with subacute left hemiplegia recovered progressively (expended disability status scale 7 to 5.5). The MR exploration demonstrated structural functional and metabolic impairments at baseline. Despite restoration of the blood brain barrier integrity, high lactate levels persisted for several weeks concomitant with glial activation. Slow and progressive structural and metabolic restorations occurred from baseline to W169 (lesion volume -64%; apparent diffusion coefficient -14.7%, magnetization transfer ratio +14%, choline -51%, lipids -78%, N-acetylaspartate +77%) while functionality of the motor system recovered.
  
  
  CONCLUSIONS
  Multimodal MRI/MRS evidenced long-term dynamics recovery processes involving tissue repair, glial activation, recovery of neuronal function and functional systems. This may impact on customized rehabilitation strategies generally focused on the first months following the onset of symptoms.
authors.affiliation: CRMBM UMR CNRS 6612-Medical School of Marseille, 13005 Marseille, France. wafaa.zaaraoui@univmed.fr
authors.forename: Wafaa
authors.initials: W
authors.lastname: Zaaraoui
authors.forename: Audrey
authors.initials: A
authors.lastname: Rico
authors.forename: Bertrand
authors.initials: B
authors.lastname: Audoin
authors.forename: Françoise
authors.initials: F
authors.lastname: Reuter
authors.forename: Irina
authors.initials: I
authors.lastname: Malikova
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Soulier
authors.forename: Patrick
authors.initials: P
authors.lastname: Viout
authors.forename: Yann
authors.initials: Y
authors.lastname: Le Fur
authors.forename: Sylviane
authors.initials: S
authors.lastname: Confort-Gouny
authors.forename: Patrick J
authors.initials: PJ
authors.lastname: Cozzone
authors.forename: Jean
authors.initials: J
authors.lastname: Pelletier
authors.forename: Jean-Philippe
authors.initials: JP
authors.lastname: Ranjeva
mesh_terms: D000208:Acute Disease; D000328:Adult; D001921:Brain / Q000473:pathology; D005260:Female; D006801:Humans; D007249:Inflammation / Q000503:physiopathology*; D008279:Magnetic Resonance Imaging / Q000379:methods*; D009682:Magnetic Resonance Spectroscopy / Q000379:methods*; D009103:Multiple Sclerosis / Q000276:immunology / Q000503:physiopathology*