title: Brainstem lesions in clinically isolated syndromes.
abstract: BACKGROUND
  Number of baseline lesions has been shown to predict future attacks and disability in clinically isolated syndromes (CIS).
  
  
  OBJECTIVE
  To investigate the role of baseline infratentorial lesions in long-term prognosis.
  
  
  METHODS
  Subjects were included in a prospective cohort of patients with CIS. Patients underwent brain MRI within 3 months after CIS onset. Number and location of lesions at baseline were prospectively studied. Retrospective scan analysis was conducted to specifically look at number and location of infratentorial lesions. We analyzed the time to a second attack and to reach EDSS 3.0.
  
  
  RESULTS
  We included 246 patients with CIS followed for a median of 7.7 years. Patients with infratentorial lesions had both a higher risk of conversion (71.4% vs 29.6%; hazard ratio [HR] 3.3; 95% confidence interval [CI] 2.2-4.8; p < 0.001) and of developing disability (32.5% vs 12.4%; HR 2.4; 95% CI 1.3-4.3; p = 0.003). Presence of at least one cerebellar lesion was associated with an increased risk of conversion (HR 2.4; 95% CI 1.3-4.5; p = 0.007). Presence of at least one brainstem lesion increased both the risk of conversion (HR 2.9; 95% CI 1.7-5.0; p < 0.001) and disability (HR 2.5; 95% CI 1.1-5.4; p = 0.026). Broken down into number of lesions, the presence of infratentorial lesions increased both the risk of conversion (83% vs 61%) (HR 22.3; 95% CI 9.7-51.1; p < 0.001) and of reaching EDSS 3.0 (40% vs 19%) (HR 3.2; 95% CI 1.3-7.4; p = 0.008) only in patients with 9 or more lesions.
  
  
  CONCLUSIONS
  Presence of infratentorial lesions increases the risk for disability. Brainstem rather than cerebellar lesions may be responsible for poor prognosis.
authors.affiliation: Unitat de Neuroimmunologia Clinica (UNIC), Edif. Escola d'infermeria planta 2, Hospital Universitari Vall d'Hebron, Pg Vall d'Hebron 119-129, 08035 Barcelona, Spain. mtintore@vhebron.net
authors.forename: M
authors.initials: M
authors.lastname: Tintore
authors.forename: A
authors.initials: A
authors.lastname: Rovira
authors.forename: G
authors.initials: G
authors.lastname: Arrambide
authors.forename: R
authors.initials: R
authors.lastname: Mitjana
authors.forename: J
authors.initials: J
authors.lastname: Río
authors.forename: C
authors.initials: C
authors.lastname: Auger
authors.forename: C
authors.initials: C
authors.lastname: Nos
authors.forename: M C
authors.initials: MC
authors.lastname: Edo
authors.forename: J
authors.initials: J
authors.lastname: Castilló
authors.forename: A
authors.initials: A
authors.lastname: Horga
authors.forename: F
authors.initials: F
authors.lastname: Perez-Miralles
authors.forename: E
authors.initials: E
authors.lastname: Huerga
authors.forename: M
authors.initials: M
authors.lastname: Comabella
authors.forename: J
authors.initials: J
authors.lastname: Sastre-Garriga
authors.forename: X
authors.initials: X
authors.lastname: Montalban
mesh_terms: D000328:Adult; D001933:Brain Stem / Q000473:pathology*; D002531:Cerebellum / Q000473:pathology; D015331:Cohort Studies; D004185:Disability Evaluation; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008279:Magnetic Resonance Imaging; D008297:Male; D009103:Multiple Sclerosis / Q000175:diagnosis* / Q000209:etiology / Q000503:physiopathology; D009187:Myelitis / Q000150:complications* / Q000175:diagnosis* / Q000503:physiopathology; D015835:Ocular Motility Disorders / Q000150:complications / Q000175:diagnosis* / Q000503:physiopathology; D009902:Optic Neuritis / Q000150:complications / Q000175:diagnosis* / Q000503:physiopathology; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012189:Retrospective Studies; D018570:Risk Assessment; D013577:Syndrome