Computerized axial tomography and diagnosis of multiple sclerosis

Bittencourt, Paulo R.M.; Kendall, Brian E.

doi:10.1590/S0004-282X1983000200007

Abstracts

Computed axial tomography (C.T.) findings are illustrated in 3 patients who presented with C.T. changes suggesting respectively chronic M.S., acute M.S., and an appearance simulating a malignant tumour. Review of the literature shows that the chronic form with cerebral atrophy and low density lesions in the hemispheres is common in patients with a long history and is unlikely to cause diagnostic difficulty. The acute presentation is less common and could be confused with a variety of causes of multiple low density enhancing lesions. The C.T. diagnosis of M.S. is more difficult in rare cases in which plaques cause mass effect and show ring enhancement; all 3 such cases in the literature were subjected to cerebral biopsy.

Os achados na tomografia axial computadorizada (C.T.) são descritos em 3 pacientes com esclerose múltipla (M.S.) que tiveram C.T. sugestiva de M.S. crônica, aguda e aguda simulando tumor cerebral. Revisão da literatura mostra que a forma crônica, com atrofia cerebral e lesões de baixa densidade nos hemisférios cerebrais, é comum em pacientes com longa história de M.S., e não deve causar dificuldade diagnostica. A apresentação aguda é menos comum e pode ser confundida com várias causas de lesões de baixa densidade que acumulam contraste intravenoso homogeneamente. O diagnóstico por C.T. é especialmente difícil quando as placas de desmielinização causam efeito de massa com deslocamento de estruturas cranianas mediais, e padrão em anel após injeção intravenosa de contraste. De 3 casos da literatura incluindo um apresentado neste trabalho, todos necessitaram biópsia cerebral para excluir causas tratáveis.

Computerized axial tomography and diagnosis of multiple sclerosis

Tomografia axial computadorizada e diagnóstico de esclerose múltipla

Paulo R.M. Bittencourt, M.D., Ph.D.^I; Brian E. Kendall, F.R.C.P., F.R.C.R.^II

^INeurologist. Department of Radiology, The National Hospital, Queen Square, London, United Kingdom

^IIConsultant radiologist. Department of Radiology, The National Hospital, Queen Square, London, United Kingdom

SUMMARY

Computed axial tomography (C.T.) findings are illustrated in 3 patients who presented with C.T. changes suggesting respectively chronic M.S., acute M.S., and an appearance simulating a malignant tumour. Review of the literature shows that the chronic form with cerebral atrophy and low density lesions in the hemispheres is common in patients with a long history and is unlikely to cause diagnostic difficulty. The acute presentation is less common and could be confused with a variety of causes of multiple low density enhancing lesions. The C.T. diagnosis of M.S. is more difficult in rare cases in which plaques cause mass effect and show ring enhancement; all 3 such cases in the literature were subjected to cerebral biopsy.

RESUMO

Os achados na tomografia axial computadorizada (C.T.) são descritos em 3 pacientes com esclerose múltipla (M.S.) que tiveram C.T. sugestiva de M.S. crônica, aguda e aguda simulando tumor cerebral. Revisão da literatura mostra que a forma crônica, com atrofia cerebral e lesões de baixa densidade nos hemisférios cerebrais, é comum em pacientes com longa história de M.S., e não deve causar dificuldade diagnostica. A apresentação aguda é menos comum e pode ser confundida com várias causas de lesões de baixa densidade que acumulam contraste intravenoso homogeneamente. O diagnóstico por C.T. é especialmente difícil quando as placas de desmielinização causam efeito de massa com deslocamento de estruturas cranianas mediais, e padrão em anel após injeção intravenosa de contraste. De 3 casos da literatura incluindo um apresentado neste trabalho, todos necessitaram biópsia cerebral para excluir causas tratáveis.

Full text available only in PDF format.

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From the Lysholm Department of Radiology, The National Hospital, Queen Square, London, United Kingdom.

Acknowledgements - The authors wish to thank Professor J. Marshall and Dr. P. C. Gautier Smith (The National Hospital) and Dr. M. Harrison (The Middlesex Hospital) for allowing presentation of patients under their care.

Departamento de Clínica Médica (Neurologia) - Hospital de Clínicas - Rua General Carneiro 180 - 80000 Curitiba, PR - Brasil.

1. ADAMS, C. W. M. - The onset and progression of the lesion in multiple sclerosis In DAVIDSON, A. N.; HUMPHREY, J. G.; LIVERSEDGE, A. L.; McDONALD. W. I. & POTTERFIELD, J. S. (eds.) - Multiple Sclerosis Research. HM Stationery Office. London, 1975, pg. 92.
2. AITA, J. F.; BENNET, D. R.; ANDERSON, R. E. & ZITER, F. - Cranial CT appearance of acute multiple sclerosis. Neurol. (Minneapolis) 26:252, 1978.
3. ANTUNES, J. L.; SCHLESINGER, E. B. & MICHELSEN, W. J. - Abnormal brain scan in demyelinating diseases. Arch. Neurol. (Chicago) 31:269, 1974.
4. AULICH, A.; LANGE, S.; STEINHOFF, H.; SCHINDLER, E. & WANDE. S. - Diagnosis and follow-up studies in brain abscess using computerized tomography. In LANKSCH, "W. & KAXNER, E. (eds.) - Cranial Computerized Tomography. Springer-Verlag. Berlin, 1976, pg. 366.
5. CARBAJAL, J. R.; PALACIOS, E.; AZAR-KIA, B. & CHURCHILL, R. - Radiology of cysticercosis of the central nervous system including computed tomography. Radiol. 125:127, 1977.
6. CLAVERIA, L. E.; KENDALL, B. E. & Du BOULAY, G. H. - Computerized axial tomography in supratentorial gliomas and metastases. In Du BOULAY, G. H. & MOSELEY, I. F. (eds.) - Computerized Axial Tomography in Clinical Practice. Springer-Verlag. Berlin, 1977, pg. 85.
7. COLE, M. & ROSS, R. J. - Plaque of multiple sclerosis teen on computerized trans-axial tomogram. Neurol. (Minneapolis) 27:890, 1977.
8. CONSTANT, P.; RENOU, A. M.; CAILLE, J. M. & VERNHIET, J. - C. A. T. studies of cerebral ischaemia. In Du BOULAY, G. H. & MOSELEY, I. F. (eds.) -Computerized Axial Tomography in Clinical Practice. Springer-Verlag. Berlin, 1977, pg. 85.
9. EGGER, J. & KENDALL, B. E. - Computed tomography in mitochondrial cytopathy. Neuroradiol. 22:73, 1981.
10. GYLDENSTED, C. - Computer tomography of the cerebrum in multiple sclerosis. Neuroradiol. 12:34, 1976.
11. HALLIDAY, A. M.; McDONALD, W. I. & MUSHIN, J. - Delayed visual evoked response in optic neuritis. Lancet 1:982, 1972.
12. HARDING, A. E.; RADUE, E. W. & WHITELEY, A. M. - Contrast-enhanced lesions on computerized tomography in multiple sclerosis. J. Neurol. Neurosurg. Psychiat. 41:754, 1978.
13. HAUGHTON, V. M.; HO, K. C.; WILLIAMS, II. L. & ELDEVILL, O. P. - CT detection of demyelinating plaques in multiple sclerosis. Am. J. Roentgenol. 132:213, 1979.
14. HERSHEY, I. A.; GADO, M. H. & TROTTER, J. L. - Computerized tomography in the diagnostic evaluation of multiple sclerosis. Ann. Neurol. 5:32, 1979.
15. KENDALL, B. E. - Symmetrical white matter low attenuation in children. X-tract 7:3, 1979.
16. KENDALL, B. E.; JAKUBOWSKI, J.; POLLICINO, P. & SYMON, L. - Difficulties in diagnosis of supratentorial gliomas by CAT scan. J. Neurol. Neurosurg. Psychiat. 42:485, 1979.
17. LEBOW, S.; ANDERSON, D. C.; MASTRI, A. & LARSON, D. - Acute multiple sclerosis with contrast-enhancing plaques. Arch. Neurol. (Chicago) 35:435, 1978.
18. LOIZOU, L. A.; KENDALL, B. E. & MARSHALL, J. - Subcortical arteriosclerotic encephalopathy: a clinical and radiological investigation. J. Neurol. Neurosurg. Psychiat. 44:294, 1981.
19. LUMSDEN, C. E. - The neuropathology of multiple sclerosis. In VINKEN, P. J. & BRUYN, G. W. (eds.) - Handbook of Clinical Neurology 9:217. North-Holland Publ. Co. Amsterdam, 1970.
20. McDONALD, W. I. - What is multiple, sclerosis? Clinical criteria for diagnosis. In DAVISON, A. N.; HUMPHREY, J. G.; LIVERSEDGE, A. L., McDONALD, W. I. & PORTERFIELD, J. S. (eds.) - Multiple Sclerosis Research. HM Stationery Office. London, 1975, pg. 1.
21. MORARIU, M. A.; WILKINS, D. E. & PATEL, S. - Multiple sclerosis and serial computerized tomography: delayed contrast enhancement of acute and early lesions. Arch. Neurol. (Chicago) 37:189, 1980.
22. MOSELEY, I. F. & RADU, E. W. - Factors in influencing the development of periventricular lucencies in patients with raised intracranial pressure. Neuroradiol. 17:65, 1979.
23. NELSON, M. J.; MILLER, S. L.; McLAIN, L. W. & GOLD, L. H. A. - Multiple sclerosis: large plaque causing mass effect and ring sign. J. comput. assist. Tomogr. 5:892, 1981.
24. RADU, E. W. & KENDALL, B. E. - Iodide and xenon enhancement of computed tomography in multiple sclerosis. Neuroradiol. 15:153, 1978.
25. ROBINSON, K. & RUDGE, P. - Auditory evoked responses in multiple sclerosis. Lancet 1:1164, 1975.
26. SEARS, E. S.; TINDALL, R. S. A. & ZARNOW, H. - Acute multiple sclerosis: enhanced computerized tomographic imaging of lesions and the effect of corticosteroids. Arch. Neurol. (Chicago) 35:426, 1978.
27. TOURTELLOTE, W. W. - What is multiple sclerosis? Laboratory criteria for diagnosis. In DAVISON, A. N.; HUMPHREY, J. G.; LIVERSEDGE, A. L.; McDONALD, W. I. & POTTERFIELD, J. S. (eds.) - Multiple Sclerosis Research. HM Stationery Office. London, 1975, pg. 9.
28. Van der VELDEN, M.; BOTS, G. T. A. M. & ENDTZ, I. J. - Cranial CT in multiple sclerosis showing a mass effect. Surg. Neurol. 12:307, 1979.
29. YOUNG, R.; HALL, A. S.; PALLIS, C. A.; LEGG, N. J.; BYDDER, G. M. & STEINER, R. E. - Nuclear magnetic resonance imaging of the brain in multiple sclerosis. Lancet 1:1063, 1981.
30. ZEE, C; SEGALL, H. D.; MILLER, C.; TSAI, F. Y.; TEAL, J. S.; HIESHIMA, G.; AHMADI, J. & HALLS, J. - Unusual neuroradiological features of intracranial cysticercosis. Radiol. 137:397, 1980.

Publication Dates

Publication in this collection
14 Aug 2012
Date of issue
June 1983

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

[1] 1. ADAMS, C. W. M. - The onset and progression of the lesion in multiple sclerosis In DAVIDSON, A. N.; HUMPHREY, J. G.; LIVERSEDGE, A. L.; McDONALD. W. I. & POTTERFIELD, J. S. (eds.) - Multiple Sclerosis Research. HM Stationery Office. London, 1975, pg. 92.

[2] 2. AITA, J. F.; BENNET, D. R.; ANDERSON, R. E. & ZITER, F. - Cranial CT appearance of acute multiple sclerosis. Neurol. (Minneapolis) 26:252, 1978.

[3] 3. ANTUNES, J. L.; SCHLESINGER, E. B. & MICHELSEN, W. J. - Abnormal brain scan in demyelinating diseases. Arch. Neurol. (Chicago) 31:269, 1974.

[4] 4. AULICH, A.; LANGE, S.; STEINHOFF, H.; SCHINDLER, E. & WANDE. S. - Diagnosis and follow-up studies in brain abscess using computerized tomography. In LANKSCH, "W. & KAXNER, E. (eds.) - Cranial Computerized Tomography. Springer-Verlag. Berlin, 1976, pg. 366.

[5] 5. CARBAJAL, J. R.; PALACIOS, E.; AZAR-KIA, B. & CHURCHILL, R. - Radiology of cysticercosis of the central nervous system including computed tomography. Radiol. 125:127, 1977.

[6] 6. CLAVERIA, L. E.; KENDALL, B. E. & Du BOULAY, G. H. - Computerized axial tomography in supratentorial gliomas and metastases. In Du BOULAY, G. H. & MOSELEY, I. F. (eds.) - Computerized Axial Tomography in Clinical Practice. Springer-Verlag. Berlin, 1977, pg. 85.

[7] 7. COLE, M. & ROSS, R. J. - Plaque of multiple sclerosis teen on computerized trans-axial tomogram. Neurol. (Minneapolis) 27:890, 1977.

[8] 8. CONSTANT, P.; RENOU, A. M.; CAILLE, J. M. & VERNHIET, J. - C. A. T. studies of cerebral ischaemia. In Du BOULAY, G. H. & MOSELEY, I. F. (eds.) -Computerized Axial Tomography in Clinical Practice. Springer-Verlag. Berlin, 1977, pg. 85.

[9] 9. EGGER, J. & KENDALL, B. E. - Computed tomography in mitochondrial cytopathy. Neuroradiol. 22:73, 1981.

[10] 10. GYLDENSTED, C. - Computer tomography of the cerebrum in multiple sclerosis. Neuroradiol. 12:34, 1976.

[11] 11. HALLIDAY, A. M.; McDONALD, W. I. & MUSHIN, J. - Delayed visual evoked response in optic neuritis. Lancet 1:982, 1972.

[12] 12. HARDING, A. E.; RADUE, E. W. & WHITELEY, A. M. - Contrast-enhanced lesions on computerized tomography in multiple sclerosis. J. Neurol. Neurosurg. Psychiat. 41:754, 1978.

[13] 13. HAUGHTON, V. M.; HO, K. C.; WILLIAMS, II. L. & ELDEVILL, O. P. - CT detection of demyelinating plaques in multiple sclerosis. Am. J. Roentgenol. 132:213, 1979.

[14] 14. HERSHEY, I. A.; GADO, M. H. & TROTTER, J. L. - Computerized tomography in the diagnostic evaluation of multiple sclerosis. Ann. Neurol. 5:32, 1979.

[15] 15. KENDALL, B. E. - Symmetrical white matter low attenuation in children. X-tract 7:3, 1979.

[16] 16. KENDALL, B. E.; JAKUBOWSKI, J.; POLLICINO, P. & SYMON, L. - Difficulties in diagnosis of supratentorial gliomas by CAT scan. J. Neurol. Neurosurg. Psychiat. 42:485, 1979.

[17] 17. LEBOW, S.; ANDERSON, D. C.; MASTRI, A. & LARSON, D. - Acute multiple sclerosis with contrast-enhancing plaques. Arch. Neurol. (Chicago) 35:435, 1978.

[18] 18. LOIZOU, L. A.; KENDALL, B. E. & MARSHALL, J. - Subcortical arteriosclerotic encephalopathy: a clinical and radiological investigation. J. Neurol. Neurosurg. Psychiat. 44:294, 1981.

[19] 19. LUMSDEN, C. E. - The neuropathology of multiple sclerosis. In VINKEN, P. J. & BRUYN, G. W. (eds.) - Handbook of Clinical Neurology 9:217. North-Holland Publ. Co. Amsterdam, 1970.

[20] 20. McDONALD, W. I. - What is multiple, sclerosis? Clinical criteria for diagnosis. In DAVISON, A. N.; HUMPHREY, J. G.; LIVERSEDGE, A. L., McDONALD, W. I. & PORTERFIELD, J. S. (eds.) - Multiple Sclerosis Research. HM Stationery Office. London, 1975, pg. 1.

[21] 21. MORARIU, M. A.; WILKINS, D. E. & PATEL, S. - Multiple sclerosis and serial computerized tomography: delayed contrast enhancement of acute and early lesions. Arch. Neurol. (Chicago) 37:189, 1980.

[22] 22. MOSELEY, I. F. & RADU, E. W. - Factors in influencing the development of periventricular lucencies in patients with raised intracranial pressure. Neuroradiol. 17:65, 1979.

[23] 23. NELSON, M. J.; MILLER, S. L.; McLAIN, L. W. & GOLD, L. H. A. - Multiple sclerosis: large plaque causing mass effect and ring sign. J. comput. assist. Tomogr. 5:892, 1981.

[24] 24. RADU, E. W. & KENDALL, B. E. - Iodide and xenon enhancement of computed tomography in multiple sclerosis. Neuroradiol. 15:153, 1978.

[25] 25. ROBINSON, K. & RUDGE, P. - Auditory evoked responses in multiple sclerosis. Lancet 1:1164, 1975.

[26] 26. SEARS, E. S.; TINDALL, R. S. A. & ZARNOW, H. - Acute multiple sclerosis: enhanced computerized tomographic imaging of lesions and the effect of corticosteroids. Arch. Neurol. (Chicago) 35:426, 1978.

[27] 27. TOURTELLOTE, W. W. - What is multiple sclerosis? Laboratory criteria for diagnosis. In DAVISON, A. N.; HUMPHREY, J. G.; LIVERSEDGE, A. L.; McDONALD, W. I. & POTTERFIELD, J. S. (eds.) - Multiple Sclerosis Research. HM Stationery Office. London, 1975, pg. 9.

[28] 28. Van der VELDEN, M.; BOTS, G. T. A. M. & ENDTZ, I. J. - Cranial CT in multiple sclerosis showing a mass effect. Surg. Neurol. 12:307, 1979.

[29] 29. YOUNG, R.; HALL, A. S.; PALLIS, C. A.; LEGG, N. J.; BYDDER, G. M. & STEINER, R. E. - Nuclear magnetic resonance imaging of the brain in multiple sclerosis. Lancet 1:1063, 1981.

[30] 30. ZEE, C; SEGALL, H. D.; MILLER, C.; TSAI, F. Y.; TEAL, J. S.; HIESHIMA, G.; AHMADI, J. & HALLS, J. - Unusual neuroradiological features of intracranial cysticercosis. Radiol. 137:397, 1980.