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Objective: To investigate changes in spontaneous brain activity in patients with relapsing-remitting multiple sclerosis (RRMS) and compare with resting-state network of healthy controls. Background Resting State connectivity using fMRI of the default-mode network (DMN) has been recently shown to be altered in patients with secondary and primary progressive MS. Dysfunction of DMN has been hypothesized to be the factor responsible for accumulation of cognitive deficits in patients with progressive MS. Design/Methods: Six patients with RRMS and 15 normal controls were scanned. fMRI images were acquired on a GE 3.0-T whole-body magnet using a gradient echo EPI sequence for whole-brain BOLD fMRI. For the resting state image set, 150 volumes were recorded while the subjects were lying quietly with eyes open. High resolution (IRSPGR) images were also acquired for brain segmentation. The brain was segmented into 104 regions using the high resolution 3D IRSPGR image and the HAMMER software and the temporal fMRI signals from all voxels in each segmented region were averaged to represent one signal for each region. Results: Resting state networks of different cognitive circuits (DMN, attention, language, memory, visual-spatial memory) were assessed in patients with MS and controls. Cross correlation of the resting state fMRI signals between every two nodes in each network was calculated for the patients and compared to the data from controls. All the pairs that had cross-correlation values outside the normal range were tagged and summed among all the patients. DMN analysis showed decreased correlation in cingulate region and lateral parietal cortices in patients with cognitive impairment, similar with a recent report in literature. Moreover, all or almost all assessed cognitive circuits showed decreased correlation in patients with MS with known cognitive deficit. Conclusions: Dysfunction of resting-state is seen in RRMS patients not only in DMN but also in other subsystems involved in cognitive process. Supported by: Henry Ford Hospital. Disclosure: Dr. Cerghet has nothing to disclose. Dr. Nejad-Davarani has nothing to disclose. Dr. Li has nothing to disclose. Dr. Jiang has nothing to disclose.

Objective: To describe the clinical and radiologic manifestations of spinal cord NS. Background Neurological involvement precedes the diagnosis of sarcoidosis in up to 74% and it is the only manifestation in up to 17% of patients. A definitive diagnosis requires histologic confirmation, which rarely is obtained. Our current knowledge for diagnosis and treatment relies on case reports. In our previous study of 71 cases with neurosarcoidosis (NS), transverse myelitis was the most common initial presentation (28%). Design/Methods: From the institutional approved NS database, 26 patients of spinal cord NS seen between 1995-2011 were selected. All patients met criteria for possible, probable or definitive NS (Zajicek et al., 1999). Neurological symptoms, socio-demographic, laboratory, radiographic and treatment data were collected. Descriptive statistics were used to characterize the NS cases. Results: Of the 26 patients, 14 (56%) had extensive intramedullary lesion, 3 (12%) had patchy intramedullary lesion(s) and 11 (44%) had leptomeningeal involvement. Patients with patchy lesion and/or leptomeningeal involvement were more likely to have elevated IgG and protein level in CSF (p=0.048; p=0.013, chi-square test). Multi-organ involvement was seen at a higher rate with leptomeningeal involvement than extensive lesions (88% vs 65%). 77% of patients had associated degenerative disease of spine, which did not appear to be associated with age. 19/26 had Gad-enhancing lesion at presentation and majority 18/21 continued to have abnormal MRI with 13/19 having enhancing lesion despite immunosuppressant treatment. 10 (40%) had a monophasic disease, 8 (32%) had relapses and 7 (28%) had a progressive disease. Conclusions: Three types of radiological presentation were seen in spinal cord NS and those are frequently associated with degenerative disease. Extensive intramedullary lesion is the most common presentation and is less likely associated with abnormal findings in CSF. Despite treatment with immunosuppression radiologic resolution is not common. Disclosure: Dr. Rai has nothing to disclose. Dr. Cerghet has nothing to disclose. Dr. Grover has nothing to disclose. Dr. Shultz has nothing to disclose. Dr. Elias has nothing to disclose.