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Case Reports
. 1990 Oct:113 ( Pt 5):1477-89.
doi: 10.1093/brain/113.5.1477.

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

A G Kermode  1 , A J Thompson, P Tofts, D G MacManus, B E Kendall, D P Kingsley, I F Moseley, P Rudge, W I McDonald
Affiliations
Case Reports

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

A G Kermode et al. Brain. 1990 Oct.

Abstract

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.

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