Breakdown of the blood-brain barrier precedes symptoms and other MRI signs of new lesions in multiple sclerosis. Pathogenetic and clinical implications

From an extensive serial magnetic resonance imaging (MRI) study in multiple sclerosis (MS) we have identified 4 cases in which disruption of the blood-brain barrier, as detected by gadolinium-DTPA enhancement, preceded other MRI abnormalities and in 1 case clinical evidence of the new lesion. This s...

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Published inBrain (London, England : 1878) Vol. 113 ( Pt 5); p. 1477
Main Authors Kermode, A G, Thompson, A J, Tofts, P, MacManus, D G, Kendall, B E, Kingsley, D P, Moseley, I F, Rudge, P, McDonald, W I
Format Journal Article
LanguageEnglish
Published England 01.10.1990
Subjects
Adult
Blood-Brain Barrier
Brain - pathology
Contrast Media
Disability Evaluation
Female
Gadolinium DTPA
Humans
Magnetic Resonance Imaging
Male
Middle Aged
Multiple Sclerosis - diagnosis
Multiple Sclerosis - metabolism
Multiple Sclerosis - physiopathology
Organometallic Compounds
Pentetic Acid
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Summary:From an extensive serial magnetic resonance imaging (MRI) study in multiple sclerosis (MS) we have identified 4 cases in which disruption of the blood-brain barrier, as detected by gadolinium-DTPA enhancement, preceded other MRI abnormalities and in 1 case clinical evidence of the new lesion. This supports the view that a defect in the blood-brain barrier, and therefore inflammation, is an early and possibly crucial event in the pathogenesis of the new lesion in MS. These cases showed a marked discrepancy between MRI abnormality and symptoms. The mechanisms contributing to this disparity are discussed, and it is concluded that far from being surprising it is to be expected.
ISSN:0006-8950
DOI:10.1093/brain/113.5.1477