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Original Research ARTICLE Provisionally accepted The full-text will be published soon. Notify me

Front. Neurol. | doi: 10.3389/fneur.2019.01085

Cranial Nerve Enhancement in Multiple Sclerosis is Associated with Younger Age at Onset and More Severe Disease

 Lukas Haider1, 2,  Wei-Shin E. Chan1,  Elisabeth Olbert3, Stephanie Mangesius4, Assunta Dal-Bianco5,  Fritz Leutmezer5, Daniela Prayer1 and Majda Thurnher1*
  • 1Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Austria
  • 2NMR Research Unit, Department of Neuroinflammation, Faculty of Brain Science,, Queen Square Multiple Sclerosis Centre, Institute of Neurology, University College London, United Kingdom
  • 3Department of Neurology, Universitätsklinikum Tulln, Austria
  • 4Univ.-Klinik für Neuroradiologie, Innsbruck Medical University, Austria
  • 5Universitätsklinik für Neurologie, Medical University of Vienna, Austria

Background: The overall frequency of cranial nerve pathology, including cranial nerves other than the trigeminal nerve, as well as its relation to brainstem lesion formation on magnetic resonance imaging (MRI) and clinical correlates in multiple sclerosis (MS) is unknown.
Objective: We aimed to determine the frequency of cranial nerve enhancement on MRI, and its association with brainstem lesion formation and clinical outcomes.

Methods: We retrospectively analysed in 183 patients (RRMS: 156, SPMS: 15, PPMS: 6, CIS: 6) 651 MRIs (76.5% on the identical scanner Siemens Trio Tim, 3T with identical MRI protocols). Frequencies of cranial nerve enhancement on post contrast T1-weighted MRIs were compared to lesion counts and the MS-severity-score.

Results: Cranial nerve enhancement was present in 8.2% of the analysed MS patients (oculomotor-nerve: 1.1%, trigeminal-nerve: 2.7%, abducens-nerve: 2.2%, facial-/vestibulocochlear nerve: 1.6%, vagal-nerve: 0.5%). Of those, 13% suffered from repeated episodes and 27% exhibited a cranial nerve enhancement duration of >12 months. Age at MS onset was lower in patients with cranial nerve enhancement, 23 vs. 28 years, p=0.049. The MS-severity-score, 5.15 vs. 0.88 (p=0.019), the T2 brainstem-, 1 vs. 0 (p=0.041), and the total intracranial contrast-enhancing lesion counts, 2 vs. 0 (p=0.000), were higher in patients with cranial nerve enhancement, compared to age-, disease duration-, and gender- matched MS patients.

Conclusions: Cranial nerve enhancement, present in 8.2% of our patients, was associated with a younger age at MS onset, brainstem lesions, and a more severe disease course.

Keywords: Multiple sclerosis, Magnetic Resonance Image (MRI), Contrast Media, Cranial nerve, brainstem, retrograde neuronal death

Received: 06 Jun 2019; Accepted: 26 Sep 2019.

Copyright: © 2019 Haider, Chan, Olbert, Mangesius, Dal-Bianco, Leutmezer, Prayer and Thurnher. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

* Correspondence: Prof. Majda Thurnher, Medical University of Vienna, Department of Biomedical Imaging and Image-Guided Therapy, Vienna, Austria, majda.thurnher@meduniwien.ac.at