Esclerose multipla : correlação clinica, liquido cefalorraquiano e neuroimagem

Autor Principal: Ernane Pires Maciel
Tipo: Teses/dissertações
Idioma: Português
Publicado em: 2003
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Multiple sclerosis (MS) is a chronic disease of the central nervous system (CNS) of unknown aetiology, which first manifestations occur in adolescence or in young adulthood, after multifocal demyelination caused by an autoimmune and inflammatory process.

The clinical evolutive sequence can take the relapsing-remitting, secondarily progressive and primary progression forms.

Diagnosis is based on the evolutive clinical manifestations, supported by cerebrospinal fluid (CSF), visual evoked responses, brain and spinal cord magnetic resonance images, with exclusion of other inflammatory or infectious diseases.

The CSF analysis in MS shows lymphocyte and monocytes pleocytosis, increase in intrathecal immunoglobulin G (IgG) synthesis and the presence of oligoclonal bands.

The albumin quotient is seldom changed in the disease.

Magnetic resonance imaging (MR) shows hyperintensities in T2 weight, proton density (PD) and fluid-attenuated inversion recovery (FLAIR) images and hypointensity in T1 weight images, in the cerebral white matter, optic nerves, brainstem and spinal cord .

The acute lesions show enhancement with contrast.

The purpose of this thesis was to evaluate the correlations between the number of cells in the liquor, the IgG index, the daily intrathecal IgG synthesis, the presence of oligo-clonal bands with: the lesion volume in FLAIR, T1 and T1 with contrast and with the lesion area in contact with the CSF space in FLAIR, T1 and T1 with contrast and the degree of disability measured by EDSS (Kurtzke?s expanded disability scale), clinical forms, duration of the disease, race and age of patients.

Seventy-one patients with clinically defined multiple sclerosis, according to Poser s criteria, had CSF analysis done with cell counting, IgG and albumin dosage by means of nephelometry and calculation of the IgG index, the daily IgG intrathecal synthesis and the albumin quotient.

The clinical data: age, race, duration of the disease, clinical form and EDSS were defined after anamnesis and neurological examination.

The volume of lesions in FLAIR, T1 and T1 with contrast was measured by means of stereology.

The lesion area in contact with the CSF space was calculated measuring manually the extension of the injured area on the ventricular wall, on the external surface of the brainstem and on the cerebral cortex and multiplying this figure by the thickness of the slices.

Of the 71 patients, 62 of them were examined by brain MR with images in FLAIR, 56 patients had images in T1 without contrast analysed and 26 patients, T1 with contrast.

The results showed a higher age average in the progressive forms, a greater IgG index in the relapsing-remitting form, a higher frequency of the exclusive oligoclonal bands in the CSF, in the cases with a greater daily intratechal synthesis of IgG.

The greater the EDSS, the higher was the albumin quotient and the daily synthesis of IgG.

The lesion area that contacts the CSF space was directly proportional to the albumin quotient, what suggests that the lesion areas around the CSF system determine a greater input of albumin, but not IgG, in the CSF system