Brain, Vol. 113, No. 5, 1477-1489, 1990
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BREAKDOWN OF THE BLOOD-BRAIN BARRIER PRECEDES SYMPTOMS AND OTHER MRI SIGNS OF NEW LESIONS IN MULTIPLE SCLEROSIS
PATHOGENETIC AND CLINICAL IMPLICATIONS
1The Multiple Sclerosis NMR Research Group, Institute of Neurology London, UK 2The National Hospitals for Nervous Diseases, Queen Square London, UK
Correspondence to:
Correspondence to Dr Allan G. Kermode, NMR Research Group. Institute of Neurology, Queen Square, London WC1N 3BG, UK.
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.
Received August 11, 1989. Accepted November 8, 1989.
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