P M Iyer1, A J Fagan2,3, J F Meaney2,3,4, N C Colgan5, S D Meredith5, D O Driscoll4, K M Curran5, D Bradley1, J Redmond6. 1. Department of Neurology, St. James's Hospital, Dublin 8, Ireland. 2. Centre for Advanced Medical Imaging, St James's Hospital, Dublin, Ireland. 3. School of Medicine, Trinity College, University of Dublin, Dublin, Ireland. 4. Department of Diagnostic Imaging, St. James's Hospital, Dublin, Ireland. 5. School of Medicine and Medical Science, and School of Electrical, Electronic and Mechanical Engineering, University College Dublin, Dublin, Ireland. 6. Department of Neurology, St. James's Hospital, Dublin 8, Ireland. jredmond@stjames.ie.
Abstract
BACKGROUND: Nystagmus in patients with multiple sclerosis (MS) is generally attributed to brainstem disease. Lesions in other regions may result in nystagmus. The identification of these other sites is enhanced by using 3-Tesla magnetic resonance imaging (3TMRI) due to increased signal-to-noise ratio. OBJECTIVE: We sought to evaluate the distribution of structural lesions and disruption of tracts in patients with horizontal nystagmus secondary to MS using 3TMRI. METHODS: Twenty-four patients (20 women, 4 men; age range 26-55 years) with horizontal nystagmus secondary to MS underwent 3TMRI brain scans; and 18 patients had diffusion tensor imaging (DTI) for tractography. RESULTS: Nystagmus was bidirectional in 11, right-sided in 6 and left-sided in 7. We identified 194 lesions in 20 regions within the neural integrator circuit in 24 patients; 140 were within the cortex and 54 were within the brainstem. Only two patients had no lesions in the cortex, and 9 had no lesions in the brainstem. There was no relationship between side of lesion and direction of nystagmus. Thirteen of 18 (72 %) had tract disruption with fractional anisotropy (FA) values below 0.2. FA was significantly lower in bidirectional compared to unidirectional nystagmus (p = 0.006). CONCLUSION: In MS patients with horizontal nystagmus, lesions in all cortical eye fields and their descending connections were evident. Technical improvements in tractography may help identify the specific site(s) resulting in nystagmus in MS.
BACKGROUND:Nystagmus in patients with multiple sclerosis (MS) is generally attributed to brainstem disease. Lesions in other regions may result in nystagmus. The identification of these other sites is enhanced by using 3-Tesla magnetic resonance imaging (3TMRI) due to increased signal-to-noise ratio. OBJECTIVE: We sought to evaluate the distribution of structural lesions and disruption of tracts in patients with horizontal nystagmus secondary to MS using 3TMRI. METHODS: Twenty-four patients (20 women, 4 men; age range 26-55 years) with horizontal nystagmus secondary to MS underwent 3TMRI brain scans; and 18 patients had diffusion tensor imaging (DTI) for tractography. RESULTS:Nystagmus was bidirectional in 11, right-sided in 6 and left-sided in 7. We identified 194 lesions in 20 regions within the neural integrator circuit in 24 patients; 140 were within the cortex and 54 were within the brainstem. Only two patients had no lesions in the cortex, and 9 had no lesions in the brainstem. There was no relationship between side of lesion and direction of nystagmus. Thirteen of 18 (72 %) had tract disruption with fractional anisotropy (FA) values below 0.2. FA was significantly lower in bidirectional compared to unidirectional nystagmus (p = 0.006). CONCLUSION: In MS patients with horizontal nystagmus, lesions in all cortical eye fields and their descending connections were evident. Technical improvements in tractography may help identify the specific site(s) resulting in nystagmus in MS.
Entities:
Keywords:
3-Tesla MRI; Digital tensor imaging; Horizontal nystagmus; Multiple sclerosis
Authors: T E J Behrens; M W Woolrich; M Jenkinson; H Johansen-Berg; R G Nunes; S Clare; P M Matthews; J M Brady; S M Smith Journal: Magn Reson Med Date: 2003-11 Impact factor: 4.668
Authors: T Scarabino; G M Giannatempo; T Popolizio; M Tosetti; V d'Alesio; F Esposito; F Di Salle; A Di Costanzo; A Bertolino; A Maggialetti; U Salvolini Journal: Radiol Med Date: 2007-02-22 Impact factor: 3.469
Authors: M P Wattjes; G G Lutterbey; J Gieseke; F Träber; L Klotz; S Schmidt; H H Schild Journal: AJNR Am J Neuroradiol Date: 2007-01 Impact factor: 3.825
Authors: Craig K Jones; Alan Huang; Jiadi Xu; Richard A E Edden; Michael Schär; Jun Hua; Nikita Oskolkov; Domenico Zacà; Jinyuan Zhou; Michael T McMahon; Jay J Pillai; Peter C M van Zijl Journal: Neuroimage Date: 2013-04-06 Impact factor: 6.556
Authors: P A Brex; J I O'Riordan; K A Miszkiel; I F Moseley; A J Thompson; G T Plant; D H Miller Journal: Neurology Date: 1999-10-12 Impact factor: 9.910
Authors: Aikaterini Christogianni; Richard Bibb; Scott L Davis; Ollie Jay; Michael Barnett; Nikos Evangelou; Davide Filingeri Journal: Temperature (Austin) Date: 2018-09-05