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Byline: Michael. Harzheim, Jeanine. Feucht, Dirk. Pauleit, Dieter. Pohlau Hashimoto's encephalopathy is a rare complication of autoimmune thyroiditis not associated with thyroidal function decline. We report a 50-year-old man presenting [...]

High field magnetic resonance imaging (MRI) provides higher lesion load measurements in patients presenting with clinically isolated syndromes (CIS) suggestive of demyelination and has impact upon the classification of these syndromes and potentially, the diagnosis of multiple sclerosis (MS). To investigate whether high field MRI can provide an earlier diagnosis of definite MS within the International Panel (IP) and Swanton criteria. Forty patients presenting with CIS suggestive of MS were included. All patients received multi-sequence MRI at 1.5 Tesla (T) and 3T as well as a neurological assessment at baseline. Follow-up visits including MRI at both field strengths and neurological examinations were scheduled 3–4 and 6–7 months after the first clinical event. Based on MRI and clinical findings, fulfilled IP criteria as well as Swanton criteria were analysed. At baseline, the higher detection rate of inflammatory lesions using high field MRI leads to higher classifications according to the Swanton criteria in 15 % of the patients. One additional patient was diagnosed with dissemination in space according to Swanton and IP criteria. During follow-up, an earlier diagnosis of definite MS could not be accomplished, neither according to the IP nor to the Swanton criteria. Although high field MRI shows a higher detection rate of inflammatory brain lesion in CIS and MS patients with an influence according to MRI criteria, this influence does not lead to an earlier diagnosis of lesion dissemination in time and therefore definite MS. [ABSTRACT FROM AUTHOR]

To prospectively investigate metabolic changes in the normal-appearing white matter (NAWM) of patients presenting with clinically isolated syndromes (CIS) suggestive of multiple sclerosis (MS) and to correlate these changes to conventional MR imaging findings in terms of MR imaging criteria. Multisequence MR imaging of the brain and 1H-MR spectroscopy of the parietal NAWM were performed in 31 patients presenting with CIS and in 20 controls using a 3. 0 T MR system. MR imaging criteria and International Panel criteria were assessed based on imaging, clinical and paraclinical results. Metabolite ratios and absolute concentrations of N-acetyl-aspartate (tNAA), myoinositol (Ins), choline (Cho), and total creatine (tCr) were determined. The metabolite concentrations were correlated with the fulfilled MR imaging criteria. In comparison to the control group, the CIS group showed significantly decreased mean tNAA concentrations (–8. 1%, p = 0. 012). Significant changes could not be detected regarding Ins, tCr and Cho. No significant correlations between absolute metabolite concentrations and MR imaging criteria were observed. Patients with and without a lesion dissemination in space showed no significant differences of their metabolite concentrations. As assessed by 1H-MRS a significant axonal damage already occurs during the first demyelinating episode in patients with CIS. Conventional MR imaging in terms of diagnostic imaging criteria does not significantly reflect NAWM disease activity in terms of metabolic alterations detected by 1H-MR spectroscopy. [ABSTRACT FROM AUTHOR]

In multiple sclerosis (MS), a crucial step in the induction phase of the inflammatory process in the central nervous system (CNS) is the disruption of the endothelial blood-brain barrier (BBB). Its permeability depends on the expression of intercellular adhesion molecules, such as vinculin and N-cadherin in endothelial cells. Interferon-gamma (IFN-gamma), as a proinflammatory cytokine, decreases the expression of both adhesion molecules in epithelial and astrocytic cells, whereas IFN-beta1a, an established treatment for MS, increases the expression of N-cadherin and vinculin in astrocytic cells and is postulated to preserve endothelial cell barrier function and to inhibit transendothelial migration of activated leukocytes. We analyzed the expression of N-cadherin and vinculin in a murine brain endothelial cell line by immunofluorescence staining and Western blot to study the presumed reversal effects of IFN-beta1a (Rebif, Serono Pharma, Unterschleissheim, Germany) and IFN-gamma on the formation of intercellular contacts. Vinculin and N-cadherin expression in brain endothelial cells was decreased after treatment with IFN-gamma, whereas stimulation with IFN-beta1a caused increased expression of both adhesion molecules. Combined treatment with both IFNs did not affect vinculin and N-cadherin expression. These data suggest that IFN-gamma contributes to BBB disruption by decreasing and IFN-beta1a restores the BBB by an upregulation of vinculin and N-cadherin expression in brain endothelial cells. This action of IFN-beta1a may contribute to its beneficial effects in MS therapy.

Multiple sclerosis (MS) is a chronic inflammatory disease characterized by multifocal demyelination and axonal damage in the central nervous system (CNS). The disruption of the endothelial blood-brain barrier (BBB) with consecutive transmigration of inflammatory cells into the brain parenchyma is of critical importance in the pathogenesis of MS. The integrity of the BBB and the adjacent network of glial cells partially depends on the assembly of intercellular contacts between astrocytes. We demonstrate that recombinant interferon-gamma (rIFN-gamma), a proinflammatory cytokine critically involved in the disruption of the BBB, downregulates the expression of the cell adhesion molecules N-cadherin and vinculin in astrocytic C6 cells using Western blot and immunofluorescence microscopy. By contrast, IFN-beta1a, an established treatment for relapsing-remitting MS, increases the expression of N-cadherin and vinculin and partly inhibits the downregulation of these adhesion molecules by phytohemagglutinin (PHA)-stimulated IFN-gamma-secreting human T lymphocytes in coculture experiments. In summary, we demonstrate that IFN-beta1a modifies the assembly of N-cadherin- and vinculin-mediated intercellular contacts between astrocytic C6 cells in vitro. This effect may also contribute to the therapeutic action of IFN-beta1a in MS.