Faculty Bibliography

We discuss the case of a patient with Progressive Multifocal Leukoencephalopathy (PML), developed after treatment with Natalizumab for 42 months for relapsing remitting multiple sclerosis (RRMS). Imaging was consistent with wide-spread PML with features that portended a high risk of development of Immune Reconstitution Inflammatory Syndrome (IRIS). After completion of plasmapheresis, she was started on oral maraviroc, chemokine receptor 5 antagonists. Our patient did not develop radiological signs or symptoms of clinical IRIS and tolerated maraviroc without adverse side-effects. We propose that maraviroc merits further examination as an agent that may prevent IRIS in patients with natalizumab-associated PML

We discuss the case of a patient with a known history of relapsing-remitting multiple sclerosis (MS) who presented with the isolated complaint of altered visual perception in the absence of abnormalities on ophthalmological examination. To the best of the authors' knowledge, this is the first documented case of both facial metamorphopsia and palinopsia occurring as the symptoms of demyelinating brain lesions consistent with an acute MS exacerbation. These symptoms appear to be related to active demyelination that either involved the optic radiations in the visual pathway or the visual association area in the temporo-occipital region of the left hemisphere.

ABSTRACT:: We describe a patient with complete, bilateral horizontal gaze palsies and facial diplegia caused by a midline tegmental pontine hemorrhage. The term "16 syndrome" (7 + 7 + (1/2) + (1/2) + (1/2) + (1/2) = 16) describes this combination of clinical findings.

Background: Multiple sclerosis (MS) in African-Americans (AAs) presents with a more rapid disease progression and poorer response to treatment than in Caucasian-Americans (CAs). AAs MS patients are characterized by significantly higher lesion load than CAs MS patients matched for age, gender and disease duration Goals: To investigate the changes in activation pattern during a simple motor task in AAs patients with MS compared with CAs patients with MS and with healthy controls. Methods: 9 AAs and 9 CAs right-handed patients with early RR-MS and preserved function of the upper limbs were recruited prospectively and compared to 9 right-handed healthy controls. All subjects underwent MRI at 3T and performed calibrated conjugated finger flexion and extension with the dominant and non-dominant hand during fMRI acquisition. Analysis of fMRI activations were performed using SPM8 (p<0.005, K=5 voxels). Whole and regional normalized brain volumes were assessed for all subjects and T2 lesion volume, EDSS, and Nine Hole Peg Test (NHPT) scores for MS patients. Results: For the task with non-dominant hand, compared with controls, AAs patients had more significant activations in left posterior cerebellar lobe, right middle frontal gyrus, and right precentral gyrus whereas CAs patients had more significant activations in left middle frontal gyrus. Compared with CAs, AAs patients had more significant activations in the left (middle) cerebellum and left medial frontal gyrus. For the task with the dominant hand, compared with controls, AAs patients had more significant activations in the right rolandic operculus whereas CAs patients did not show any difference. Compared with CAs, AAs patients had more significant activations in the supplementary motor area, right temporal and limbic lobe, left post-central lobe, right supramarginal lobe and right rolandic operculus. In both AAs and CAs patients, correlations were found between activations of cortical areas and T2LV, EDSS and NHPT (multiple regression analysis SP!