Friday, May 20, 2022

What Do Brain Lesions Look Like

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General Considerations When Using Mri For The Diagnosis Of Multiple Sclerosis

What does it feel like to have more than 50 brain lesions with Multiple Sclerosis?

There are general considerations when applying the MRI aspects of the 2017 revision of the McDonald criteria in the diagnostic work-up of patients with suspected multiple sclerosis:

The clinical syndrome should be typical of demyelination.

  • The criteria should be applied to adult patients however, they also perform well in identifying paediatric patients with multiple sclerosis from those suffering from monophasic demyelination , although special care is needed in patients under 11 years . In paediatric cases, the presence of at least one black hole and at least one periventricular lesion at baseline contribute to distinguish children with multiple sclerosis from those with monophasic demyelination . For a comprehensive review of multiple sclerosis differential diagnosis in pediatric population, which is beyond the scope of this review, see .

  • In patients older than 50 years or with vascular risk factors, more stringent criteria should be considered .

  • MRI studies should be of adequate quality, with few artefacts and performed on scanners with a minimum field strength of 1.5 T. Using 3D acquisitions or 2D with 3-mm thick slices and no gap between slices will increase diagnostic yield.

  • Key MRI sequences include T2-weighted and T1 pre- and post-gadolinium images of the brain and the spinal cord .

  • Fat-suppressed MRIs of the optic nerves should be considered especially in atypical cases to rule out possible alternative diagnoses.

  • Conversion And Psychogenic Disorders

    Conversion and psychogenic disorders are conditions in which psychological stress is converted into a physical problem such as blindness or paralysis for which no medical cause can be found. In a study published in September 2016 in the journal Neurology, 11 percent of subjects definitely or probably misdiagnosed with MS actually had a conversion or psychogenic disorder.

    Uncovering The Hidden Side Of Brain Lesions

      Much of our existing knowledge about the workings of the healthy brain comes from studying patients who have suffered brain injuries, for example, due to a stroke. However, despite this, we still have little idea of the impact which brain damage has on the networks of neuronal connections across the whole brain which underlie key cognitive functions. Dr Michel Thiebaut de Schotten and colleagues at the ICM Institute in Paris have developed a software package called BCBtoolkit which can help researchers and clinicians understand the effects of brain damage on brain connections. In future, this could help evolve our understanding of higher brain processes, as well as helping neurologists to predict whether a patient will recover or not from a stroke or other brain injuries.

      Brain lesions are areas of abnormal tissue that have been damaged due to injury or disease, which can range from being relatively harmless to life-threatening. Clinicians typically identify them as unusual dark or light spots on CT or MRI scans which are different from ordinary brain tissue.

      How do brain lesions impact brain function? Traditionally, if a patient has a lesion in a certain part of their brain, and displays a particular set of symptoms, such as reduced spatial awareness or impaired language production, neurologists deduce that these symptoms are a direct result of functional changes in the visibly damaged area.


      Research Objectives



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      How Are Brain Lesions Treated

      Treatment varies in each individual case depending on the type of lesion, its location, and cause. It is important that a thorough examination be completed by a doctor to develop the appropriate treatment plan.

      The treatment options depend on the type of lesions and severity of symptoms. Usually medicines can be used to treat the underlying cause. Surgery may be an option in some cases, such as when the lesions are caused by a brain tumor.

      Sometimes, lesions and symptoms dont improve even after appropriate diagnosis and proper treatment and the goal is to manage symptoms.

      Last reviewed by a Cleveland Clinic medical professional on 05/07/2018.


      New Findings Could Alter How Doctors Predict Whose Disease Will Become More Severe

      Typical MS with brain lesions.
      University at Buffalo
      For decades, clinicians treating multiple sclerosis have interpreted the appearance of new or expanding brain lesions on magnetic resonance imaging scans as a sign that a patient’s disease is getting worse. Now researchers are finding that it may be the atrophy or disappearance of these lesions into cerebrospinal fluid that is a better indicator of who will develop disability.

      For decades, clinicians treating multiple sclerosis have interpreted the appearance of new or expanding brain lesions on magnetic resonance imaging scans as a sign that a patient’s disease is getting worse. Now, University at Buffalo researchers are finding that it may be the atrophy or disappearance of these lesions into cerebrospinal fluid that is a better indicator of who will develop disability.

      The five-year study, conducted by MS researchers in the Jacobs School of Medicine and Biomedical Sciences at UB, was published in the Journal of Neuroimaging. Similar findings also resulted from their 10-year study of 176 patients that they presented at the annual meeting of the American Academy of Neurology in Los Angeles in April.

      Zivadinov, a professor of neurology in the Jacobs School and director of the Buffalo Neuroimaging Analysis Center in the Jacobs School, also directs the Center for Biomedical Imaging at UB’s Clinical and Translational Science Institute.

      Brain lesions and MS

      Lesions disappearing into cerebrospinal fluid

      More robust than whole brain atrophy

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      Complementary Therapies For Ms

      Many nontraditional therapies for MS have not been well studied. Some people say acupuncture relieves symptoms such as muscle spasms and pain, but research to confirm its value isn’t conclusive. Others have reported benefits from injections of bee venom, but a rigorous study, lasting 24 weeks, showed no improvements in disability, fatigue, or the number of MS attacks. It’s important to inform your doctor about any supplements, special diets, or other therapies you want to try.

      Multiple Sclerosis: Its In Your Head

      Multiple sclerosis is a disease of the central nervous system that causes damage to your brain, spinal cord, and optic nerves. Its characterized by lesions, or areas of tissue damage that occur when your immune system behaves abnormally and attacks these areas.

      While many symptoms of MS throughout the body can be caused by lesions in either the brain or the spinal cord, cognitive symptoms of MS those related to your memory, language, and problem solving are believed to be caused only by lesions in the brain.

      Brain lesions are a hallmark of MS, but theyre not the only way MS can affect your brain function. MS can also contribute to brain atrophy, or shrinkage, over time a process that occurs in all people as they age, but typically happens much more quickly in people with MS. Brain atrophy, in particular, can contribute to cognitive symptoms of MS.

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      The Ms Lesion Checklist

      The MS Lesion Checklist provides brief definitions for 10 types of lesions that are best appreciated on axial or sagittal T2-weighted and fluid-attenuated inversion recovery sequences. Typical examples are shown in Figures 1-8. Only lesions that conform to a description in The MS Lesion Checklist should be regarded as distinctly MS-like. For example, Dawsons fingers must be firmly in contact with the ventricles, as originally described by Dawson.3 Juxtacortical lesions, best seen on FLAIR sequences should be contiguous with cortex.4 MS brainstem lesions may be seen more clearly on T2W sequence than FLAIR and should only be considered distinctly MS-like if they border the subarachnoid space or a ventricle .5 MS corpus callosum lesions should border callososeptal interface on sagittal FLAIR as in Figure 7.

      Figure 1. Nerve root entry zone lesion. Arrow: Lesion along left trigeminal root the trigeminal nerves are seen in the prepontine cisterns.

      Figure 2. Cerebellar hemisphere lesions. Two small demyelinating lesions are seen in the right cerebellar hemisphere. Note there is also a typical peripheral brainstem lesion that appears to track along the left glossopharyngeal nerve root.

      Figure 3. Middle cerebellar peduncle lesions. Bilateral middle cerebellar peduncle lesions as well as lesions within basilar pons and cerebellar hemispheres.

      Other Ways To Keep Your Brain Healthy

      LOOKING INSIDE MY BRAIN! | What a Large Brain Tumor Looks Like

      Multiple sclerosis is a chronic illness with no known cure. Regular monitoring and follow-up care are important parts of tracking and managing disease progression. Brain lesions can be caused or worsened by things other than MS, such as aging or stroke.

      Maintaining a generally healthy lifestyle, including diet and exercise, can also go a long way toward keeping your brain functioning smoothly, whether or not you have MS. There are several things you can do to help keep your brain healthy when you have multiple sclerosis.

      Here are some ways to limit your risk for new or worsening brain lesions:

      • Stop smoking. Toxins in cigarette smoke can exacerbate brain lesions and their symptoms. Studies have shown people who smoke are more likely to develop MS.
      • Control your blood pressure. Vascular disease and issues such as stroke and high blood pressure can cause lesions in the brain.
      • Eat a healthy diet. Diets high in excess fats have been linked to lesions in the brain. Maintaining a heart-healthy diet that is low in fat and cholesterol can reduce the likelihood of more lesions.
      • Wear a helmet when riding your bike or playing contact sports. Traumatic brain injury can cause or worsen lesions.

      When you join MyMSTeam, you gain a support group of more than 160,000 other people who are living with multiple sclerosis. Brain lesions are a frequent topic of conversation among MyMSTeam members.

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      Can A Brain Lesion Be An Incidental Finding

      Multimedia. Usually, a brain lesion is an incidental finding unrelated to the condition or symptom that led to the imaging test in the first place. A brain lesion may involve small to large areas of your brain, and the severity of the underlying condition may range from relatively minor to life-threatening.

      A brain lesion is an abnormality seen on a brain-imaging test, such as magnetic resonance imaging or computerized tomography . On CT or MRI scans, brain lesions appear as dark or light spots that dont look like normal brain tissue.

      How Does Ms Progress

      MS is different in every person. Doctors usually see four forms:

      Relapsing-remitting: Symptoms flare during acute attacks, then improve nearly completely or “remit.” This is the most common form of MS.

      Primary-progressive: MS slowly but steadily worsens.

      Secondary-progressive: Begins as relapsing-remitting type, then becomes progressive.

      Progressive-relapsing: The underlying disease steadily worsens. The patient has acute relapses, which may or may not remit. This is the least common form of MS.

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      What Is The Difference Between Brain Lesions And Brain Cancer

      A brain lesion is damage to any part of the brain, and can result from trauma, disease, or other problems. Brain cancer refers specifically to cancerous cells in the brain that may form a tumor.

      Benign brain tumors are slow growing and do not spread to other parts of the body. These types of tumors are usually harmless but can be life threatening depending on its location.

      Malignant tumors, on the other hand, can destroy tissue or disrupt the bodys normal function by putting pressure on surrounding structures.

      The Symptoms of Both Brain Lesions and Cancer are Similar, and Include:

      • Changes in the ability to talk, hear, or see
      • Changes in mood or behavior
      • Feeling weak or sleepy
      • Problems with balance or walking
      • Problems with thinking or memory
      • Seizures

      What Does It Mean When You Have Lesions On Your Brain


      One such condition is lesions on brain. Brain lesions can be defined as destruction or damage of any part of brain. Lesions can be due to any disease, trauma or it might be the result of some birth defects. Such lesions might be localized to specific area of brain or might include a large part of brain tissues.

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      Preventing Misdiagnosis Of Brain Lesions

      What are some common pitfalls in imaging of brain lesions that patients should be aware of?

      Brain imaging is complex and many lesions can look almost the same – while representing different entities. The radiologist typically works closely with the patients physicians to make sure the latter has the best information to make their care decisions with their patient.

      Because brain lesions can be tricky, interpretation from a neuroradiologist with subspecialty training and experience is very important in avoiding potential pitfalls.

      How can patients help ensure they are not misdiagnosed?

      The most important element in my mind is good communication with their physician. Patients should ask their doctors as many questions as they have, until they have all been answered.

      Juxtacortical Or Cortical Lesions

      A juxtacortical lesion is defined as a T2-hyperintense white matter lesion abutting, i.e. in direct contact with, the cortex without intervening normal white matter. They are best detected using a T2-FLAIR sequence . In multiple sclerosis, juxtacortical lesions typically involve the U-fibres and can be located in all brain lobes and in the cerebellum .

      Characteristics of cortical/juxtacortical multiple sclerosis that are typical and atypical , as well as those that should not be included.Top left: Green flags: examples of juxtacortical lesions and cortical lesions suggestive of multiple sclerosis. Top right: white matter lesions not touching the cortex or within the cortex . Bottom: Red flags: multiple white matter lesions involving subcortical and deep white matter, suggestive of small-vessel disease lesions involving the grey matter-white matter border of different brain lobes with ill-defined borders in progressive multifocal leukoencephalopathy multiple well-defined CSF-like abnormalities that appear as dots or stripes in enlarged Virchow-Robin space hypointensity on T2-weighted sequence suggesting haemosiderin deposit due to a microbleed multiple leptomeningeal/cortical hyperintensities on T1-weighted imaging with associated hypointensity on gradient-echo sequence in CNS vasculitis. JC/CL = juxtacortical/cortical.

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      Using Mri To Diagnose Ms

      MRI scans provide a significant amount of information that doctors use to diagnose MS and assess the status of people with the condition.

      These scans can detect damage in the central nervous system, which comprises the brain and spinal cord. MS-related lesions appear on MRI images as either bright or dark spots, depending on the type of MRI used.

      This imaging technique is useful because it shows active inflammation and helps doctors determine the age of the lesions. Also, some specific types of lesion can indicate a flare-up of MS or damage in the brain. It is a good idea for anyone with MS to have regular scans so that a doctor can assess the progression of the disease.

      Below, we list some of the main MRI scanning techniques.

      Facts You Should Know About Brain Lesions

      Do Brain Tumors Require Surgery?
      • The brain is perhaps the most important organ in the body, responsible for the unconscious autonomic activities like breathing, blood pressure and temperature control, sensation, movement, and thought processes.
      • Neurons and glia are the two types of cells that make up the brain.
      • Each area of the brain has a responsibility for brain function.
      • A brain lesion describes an area of damaged brain. It may be isolated or there may be numerous areas affected.
      • Symptoms of a brain lesion depend upon what part of the brain is affected and may be minimal or life-threatening.
      • Diagnosis of brain lesions begin with a careful history and physical examination of the affected individual. The brain may be imaged in a variety of ways including CT, MRI and angiography.
      • Treatment and prognosis of brain lesions depend upon the underlying illness or injury, and the amount of damage sustained by the brain.

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      T2 And Pd Weighted Imaging

      T2 weighted imaging identifies MS lesions as high signal foci against the low signal background of white matter. However, periventricular lesions are often indistinguishable from the adjacent CSF which is also of high signal with T2 weighting. Contrast from the lesion can be improved here by using PD weighting because of the lower CSF signal with this sequence. Fortunately, T2 and PD weighted images can be acquired together in a single spin-echo sequence providing complimentary information .

        Figure 1

        Axial magnetic resonance imaging of a 30 year old man with relapsing remitting multiple sclerosis showing multiple periventricular lesions: T2 weighted image proton density weighted image fluid attenuated inversion recovery image T1 weighted image following administration of gadolinium demonstrating enhancing lesions.

        Mri Assessment Of Prognosis

        Patients presenting with a CIS will often ask about the likelihood of developing MS in the future and also about the development of disability. The latter question is also relevant in patients who have recently been diagnosed with relapsingremitting MS who have no significant disability. Several factors have a modest influence on prognosis including type of initial presentation and appearances on MRI scan.

        The likelihood of subsequent development of MS has been addressed in natural history studies of CIS. Based on data from these studies, approximately 5060% of all CIS patients will go on to develop MS in the long term. If an MRI scan at presentation is abnormal the likelihood of developing MS is increased to 6080%, and if the scan is normal the risk is reduced substantially to approximately 20%. Patients with optic neuritis seem to have a lower risk of converting to MS in some studies where they have shown a lower frequency of MRI lesion than other types of CIS.

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        The Criteria For A Diagnosis Of Ms

        To make a diagnosis of MS, the physician must:

        • Find evidence of damage in at least two separate areas of the central nervous system , which includes the brain, spinal cord and optic nerves AND
        • Find evidence that the damage occurred at least one month apart AND
        • Rule out all other possible diagnoses.

        In 2001, the International Panel on the Diagnosis of Multiple Sclerosis updated the criteria to include specific guidelines for using magnetic resonance imaging , visual evoked potentials and cerebrospinal fluid analysis to speed the diagnostic process. These tests can be used to look for a second area of damage in a person who has experienced only one attack of MS-like symptoms referred to as a clinically isolated syndrome . A person with CIS may or may not go on to develop MS.

        The criteria were further revised in 2005 and again in 2010 to make the process easier and more efficient.

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