Demyelinating lesions as incidental findings in magnetic resonance imaging: a study of 11 cases with clinico-radiological follow-up and a review of the literature

Introduction. The widespread application of magnetic resonance imaging (MRI) has brought with it an increase in the detection of alterations in the white matter of the central nervous system Aim. To investigate the evolution of patients with no previous neurological symptoms, but in whom MRI findings are highly suggestive of multiple sclerosis (MS) Patients and methods. We conducted a descriptive study of 11 patients with MRI findings suggesting MS A longitudinal follow-up was used to determine the radiological progression and conversion into an isolated neurological syndrome and clinically defined MS Results. Eleven patients (seven females and four males) were identified, with a mean age of 36 years (range 28-48 years), who had been submitted to an MRI scan due to headache (n = 2), radiculalgia (n = 3), traumatic brain injury (n = 1), syncope (n = 1), peripheral nervous pathology (n = 1) and epileptic seizures (n = 1) The mean number of Barkhof-Tintore criteria in the initial MRI scan was three The oligoclonal band study was positive in six cases and in nine patients visual evoked potentials were performed (three pathological) The mean follow-up time was 2 9 years (range . 2 months-11 9 years). The mean amount of time elapsed between the first and the second MRI scan was 2 03 years. A radiological progression was identified in seven cases (five of them with gadolinium uptake) Five patients became cases of isolated neurological syndrome, with a mean amount of time since the initial MRI scan of 413 years Of these, three patients presented conversion into clinically defined MS, two into the relapsing-remitting form (after an average of 8.54 years since the initial MRI scan) and another into the primary progressive form Conclusions. The identification of incidental lesions that are highly suggestive of MS could help to constitute a group of subjects with an increased risk of developing MS