Summary on magnetic resonance imaging, and pathological and clinical characteristics of 26 multiple sclerosis patients with new lesion in medulla oblongata_West China Medical Journal

Authors：

HU Xiaohui ¹ , YANG Yan ² ,  GONG Daokai ¹

1. Department of Neurology, Jingzhou Central Hospital, Jingzhou Clinical Medical College, Yangtze University, Jingzhou 434020, P. R. China;
2. Hubei College of Chinese Medicine, Jinzhou, Hubei 434020, P. R. China;

Corresponding author：

GONG Daokai, Email: smilewheeler@163.com

Keywords：

Multiple sclerosis; Medulla; Neurogenic pulmonary edema; Left ventricular apical ballooning syndrome; Nystagmus

DOI：

10.7507/1002-0179.201610169

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ObjectiveTo evaluate the magnetic resonance imaging (MRI) manifestations, pathological and clinical characteristics, and treatment outcomes of multiple sclerosis (MS) patients with new lesion in medulla oblongata (MO).MethodsPubMed, EBSCO, and Springer databases between January 1st, 2000 and May 1st, 2018 were searched with the combined keywords of " multiple sclerosis” and " medulla oblongata”. Furthermore, the MS patients’ MRI manifestations, pathological and clinical characteristics, and treatment outcomes were summarized.ResultsA total of 18 papers were involved, in which 26 patients were included. The lesions in MO were mainly showed by wedge-shape (9/20), and round or oval-shape (9/20) in axial head MRI. Inflammatory cells infiltration and acute demyelination in the new lesions of MO had been displayed by autopsy reports of two MS patients. The new lesions in MO mainly referred to various types of nystagmus (9/26), left ventricular apical ballooning syndrome (LVABS) (8/26), neurogenic pulmonary edema (NPE) (6/26), and acute heart failure (6/26). Nucleus tracts solitaries (NTS), along with dorsal motor nucleus of the vagus nerve and medial reticular formation (MRF), was related to LVABS and NPE. Intercalatus nucleus, Roller nucleus and/or autonomic nerve structure were related to various types of nystagmus.ConclusionsIn axial head MRI, the new MS lesions in MO were mainly wedge-shape and round or oval-shape. Beyond that, the new MS lesions in MO could involve NTS, dorsal motor nucleus of the vagus nerve, MRF, intercalatus nucleus, Roller nucleus and/or autonomic nerve structure, resulting in special clinical features, such as, nystagmus, LVABS, NPE, and acute heart failure. Corticosteroid is still the main treatment to relieve the clinical manifestations caused by new MS lesions in MO.

Citation： HU Xiaohui, YANG Yan, GONG Daokai. Summary on magnetic resonance imaging, and pathological and clinical characteristics of 26 multiple sclerosis patients with new lesion in medulla oblongata. West China Medical Journal, 2018, 33(6): 691-695. doi: 10.7507/1002-0179.201610169 Copy

1.	Chen H, Liu SM, Zhang XX, et al. Clinical features of patients with multiple sclerosis and neuromyelitis optica spectrum disorders. Chin Med J (Engl), 2016, 129(17): 2079-2084.
2.	张星虎. 多发性硬化的临床诊断. 中国现代神经疾病杂志, 2012, 12(2): 122-126.
3.	胡学强, 麦卫华, 王敦敬. 多发性硬化413例患者的临床表现特点. 中华神经科杂志, 2004, 37(1): 7-10.
4.	Crawley F, Saddeh I, Barker S, et al. Acute pulmonary oedema: presenting symptom of multiple sclerosis. Mult Scler, 2001, 7(1): 71-72.
5.	Midaglia L, Juega Mariño JM, Sastre-Garriga J, et al. An uncommon first manifestation of multiple sclerosis: Tako-Tsubo cardiomyopathy. Mult Scler, 2016, 22(6): 842-846.
6.	刘红升, 苏琴, 赵晓东, 等. 神经源性肺水肿早期形式的急诊识别及治疗. 中国医学科学院学报, 2015, 37(3): 343-347.
7.	Minagar A, Sheremata WA, Tusa RJ. Perverted head-shaking nystagmus: a possible mechanism. Neurology, 2001, 57(5): 887-889.
8.	van de Beek MT, Taal W, Veldkamp RF, et al. A Woman with multiple sclerosis and pink saliva. Lancet Neurol, 2003, 2(4): 254-255.
9.	de Seze J, Zephir H, Hautecoeur P, et al. Pathologic laughing and intractable hiccups can occur early in multiple sclerosis. Neurology, 2006, 67(9): 1684-1686.
10.	Bramow S, Faber-Rod JC, Jacobsen C, et al. Fatal neurogenic pulmonary edema in a patient with progressive multiple sclerosis. Mult Scler, 2008, 14(5): 711-715.
11.	Qiu W, Raven S, Wu JS, et al. Wedge-shaped medullary lesions in multiple sclerosis. J Neurol Sci, 2010, 290(1/2): 190-193.
12.	Wipfler P, Pilz G, Broussalis E, et al. Acute pulmonary edema caused by a multiple sclerosis relapse. J Neurol, 2011, 258(6): 1176-1179.
13.	Hengstman GJ, Kusters B. Sudden cardiac death in multiple sclerosis caused by active demyelination of the medulla oblongata. Mult Scler, 2011, 17(9): 1146-1148.
14.	Adamec I, Gabelić T, Krbot M, et al. Primary position upbeat nystagmus. J Clin Neurosci, 2012, 19(1): 161-162.
15.	James PB. Hyperbaric oxygenation in fluid microembolism. Neurol Res, 2007, 29(2): 156-161.
16.	Kim Ha YH, Lee H. Can upbeat nystagmus increase in downward, but not upward, gaze?. J Clin Neurosci, 2012, 19(4): 600-601.
17.	Agarwal PK, Lim LT, Park S, et al. Alternating Horner’s syndrome in multiple sclerosis. Semin Ophthalmol, 2012, 27(1/2): 40-41.
18.	Plummer C, Campagnaro R. Flash pulmonary edema in multiple sclerosis. J Emerg Med, 2013, 44(2): e169-e172.
19.	Pula JH, Newman-Toker DE, Kattah JC. Multiple sclerosis as a cause of the acute vestibular syndrome. J Neurol, 2013, 260(6): 1649-1654.
20.	Kim JA, Jeong IH, Lim YM, et al. Primary position upbeat nystagmus during an acute attack of multiple sclerosis. J Clin Neurol, 2014, 10(1): 37-41.
21.	Kozu K, Suzuki H, Nishiyama S, et al. Multiple sclerosis lesion in the medulla oblongata in a patient with takotsubo cardiomyopathy. Int J Cardiol, 2016, 222: 980-981.
22.	Androdias G, Bernard E, Biotti D, et al. Multiple sclerosis broke my heart. Ann Neurol, 2017, 81(5): 754-758.
23.	Polman CH, Reingold SC, Banwell B, et al. Diagnostic criteria for multiple sclerosis: 2010 revisions to the McDonald criteria. Ann Neurol, 2011, 69(2): 292-302.
24.	Gass A, Rocca MA, Agosta F, et al. MRI monitoring of pathological changes in the spinal cord in patients with multiple sclerosis. Lancet Neurol, 2015, 14(4): 443-454.
25.	胡丽萍. 多发性硬化的MRI表现特征及诊断价值. 华西医学, 2015, 30(6): 1101-1104.
26.	Sati P, George IC, Shea CD, et al. FLAIR*: a combined Mr contrast technique for visualizing white matter lesions and parenchymal veins. Radiology, 2012, 265(3): 926-932.
27.	王晔, 郭大文, 王德生. 上跳性眼震与下跳性眼震. 国际神经病学神经外科学杂志, 2007, 34(1): 93-96.
28.	Busl KM, Bleck TP. Neurogenic pulmonary edema. Crit Care Med, 2015, 43(8): 1710-1715.
29.	Inamasu J, Sugimoto K, Yamada Y, et al. The role of catecholamines in the pathogenesis of neurogenic pulmonary edema associated with subarachnoid hemorrhage. Acta Neurochir (Wien), 2012, 154(12): 2179-2184; discussion 2184-2185.

1. Chen H, Liu SM, Zhang XX, et al. Clinical features of patients with multiple sclerosis and neuromyelitis optica spectrum disorders. Chin Med J (Engl), 2016, 129(17): 2079-2084.
2. 张星虎. 多发性硬化的临床诊断. 中国现代神经疾病杂志, 2012, 12(2): 122-126.
3. 胡学强, 麦卫华, 王敦敬. 多发性硬化413例患者的临床表现特点. 中华神经科杂志, 2004, 37(1): 7-10.
4. Crawley F, Saddeh I, Barker S, et al. Acute pulmonary oedema: presenting symptom of multiple sclerosis. Mult Scler, 2001, 7(1): 71-72.
5. Midaglia L, Juega Mariño JM, Sastre-Garriga J, et al. An uncommon first manifestation of multiple sclerosis: Tako-Tsubo cardiomyopathy. Mult Scler, 2016, 22(6): 842-846.
6. 刘红升, 苏琴, 赵晓东, 等. 神经源性肺水肿早期形式的急诊识别及治疗. 中国医学科学院学报, 2015, 37(3): 343-347.
7. Minagar A, Sheremata WA, Tusa RJ. Perverted head-shaking nystagmus: a possible mechanism. Neurology, 2001, 57(5): 887-889.
8. van de Beek MT, Taal W, Veldkamp RF, et al. A Woman with multiple sclerosis and pink saliva. Lancet Neurol, 2003, 2(4): 254-255.
9. de Seze J, Zephir H, Hautecoeur P, et al. Pathologic laughing and intractable hiccups can occur early in multiple sclerosis. Neurology, 2006, 67(9): 1684-1686.
10. Bramow S, Faber-Rod JC, Jacobsen C, et al. Fatal neurogenic pulmonary edema in a patient with progressive multiple sclerosis. Mult Scler, 2008, 14(5): 711-715.
11. Qiu W, Raven S, Wu JS, et al. Wedge-shaped medullary lesions in multiple sclerosis. J Neurol Sci, 2010, 290(1/2): 190-193.
12. Wipfler P, Pilz G, Broussalis E, et al. Acute pulmonary edema caused by a multiple sclerosis relapse. J Neurol, 2011, 258(6): 1176-1179.
13. Hengstman GJ, Kusters B. Sudden cardiac death in multiple sclerosis caused by active demyelination of the medulla oblongata. Mult Scler, 2011, 17(9): 1146-1148.
14. Adamec I, Gabelić T, Krbot M, et al. Primary position upbeat nystagmus. J Clin Neurosci, 2012, 19(1): 161-162.
15. James PB. Hyperbaric oxygenation in fluid microembolism. Neurol Res, 2007, 29(2): 156-161.
16. Kim Ha YH, Lee H. Can upbeat nystagmus increase in downward, but not upward, gaze?. J Clin Neurosci, 2012, 19(4): 600-601.
17. Agarwal PK, Lim LT, Park S, et al. Alternating Horner’s syndrome in multiple sclerosis. Semin Ophthalmol, 2012, 27(1/2): 40-41.
18. Plummer C, Campagnaro R. Flash pulmonary edema in multiple sclerosis. J Emerg Med, 2013, 44(2): e169-e172.
19. Pula JH, Newman-Toker DE, Kattah JC. Multiple sclerosis as a cause of the acute vestibular syndrome. J Neurol, 2013, 260(6): 1649-1654.
20. Kim JA, Jeong IH, Lim YM, et al. Primary position upbeat nystagmus during an acute attack of multiple sclerosis. J Clin Neurol, 2014, 10(1): 37-41.
21. Kozu K, Suzuki H, Nishiyama S, et al. Multiple sclerosis lesion in the medulla oblongata in a patient with takotsubo cardiomyopathy. Int J Cardiol, 2016, 222: 980-981.
22. Androdias G, Bernard E, Biotti D, et al. Multiple sclerosis broke my heart. Ann Neurol, 2017, 81(5): 754-758.
23. Polman CH, Reingold SC, Banwell B, et al. Diagnostic criteria for multiple sclerosis: 2010 revisions to the McDonald criteria. Ann Neurol, 2011, 69(2): 292-302.
24. Gass A, Rocca MA, Agosta F, et al. MRI monitoring of pathological changes in the spinal cord in patients with multiple sclerosis. Lancet Neurol, 2015, 14(4): 443-454.
25. 胡丽萍. 多发性硬化的MRI表现特征及诊断价值. 华西医学, 2015, 30(6): 1101-1104.
26. Sati P, George IC, Shea CD, et al. FLAIR*: a combined Mr contrast technique for visualizing white matter lesions and parenchymal veins. Radiology, 2012, 265(3): 926-932.
27. 王晔, 郭大文, 王德生. 上跳性眼震与下跳性眼震. 国际神经病学神经外科学杂志, 2007, 34(1): 93-96.
28. Busl KM, Bleck TP. Neurogenic pulmonary edema. Crit Care Med, 2015, 43(8): 1710-1715.
29. Inamasu J, Sugimoto K, Yamada Y, et al. The role of catecholamines in the pathogenesis of neurogenic pulmonary edema associated with subarachnoid hemorrhage. Acta Neurochir (Wien), 2012, 154(12): 2179-2184; discussion 2184-2185.

West China Medical Journal

Summary on magnetic resonance imaging, and pathological and clinical characteristics of 26 multiple sclerosis patients with new lesion in medulla oblongata

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