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Histologically, chronic demyelinating lesions in multiple sclerosis (MS) have been shown to include inactive lesions that do not change over time and active or “smouldering" lesions that tend to enlarge over time and are surrounded by pro-inflammatory activated microglial cells that are loaded with iron. To identify “smouldering" foci of demyelination and assess the “latent” inflammatory process in the brain, MRI sequences sensitive to the detection of substances with paramagnetic properties, including iron, must be used. They include an innovative technique such as quantitative susceptibility mapping (QSM).Objective: to identify, using MRI different types of chronic demyelination foci in MS, based on iron distribution and the degree of damage (myelination) in their structure.Material and methods. The patterns of iron distribution in demyelinating lesions in 90 MS patients were investigated using QSM. In addition, two lesions with different iron distribution patterns were randomly selected on the QSM map for each patient, in which the magnetic transfer ratio (MTR), indirectly reflecting the degree of myelination, was calculated. The identified changes were also compared with visualization of lesions in standard MRI modes (T1 MPRAGE, T2 FLAIR).Results. Despite the predominantly identical visualization in T2 FLAIR mode, chronic foci of demyelination show different patterns on the QSM maps, which is due to the peculiarities of iron distribution: some foci are not detected on QSM, while others are visualized either in the form of a homogeneous or a ring-shaped pattern. When comparing QSM data with MTR, it was found that MTR indicators were highest in non-visualized lesions (demyelination is minimal), while damage was most pronounced in lesions with ring-shaped iron distribution.Conclusion. Different patterns of iron distribution in demyelination foci compared to the degree of myelination in these foci according to MTR were identified using QSM, which is of great importance for the evaluation of latent inflammation and the development of the neurodegenerative process in MS.

Optic neuritis (ON) can often occur at the onset of a demyelinating autoimmune CNS disease or as one of its clinical manifestations. The introduction of novel laboratory techniques, technical advances in magnetic resonance imaging (MRI), electrophysiologic studies, and ocular imaging have significantly expanded the spectrum of autoimmune optic neuropathies. Identification of different forms of ON based on clinical and instrumental data can lead to early diagnosis of the underlying neurologic disorder. According to current guidelines, one can distinguish between typical ON, which are mainly associated with multiple sclerosis (MS), and atypical ON, which are the main clinical manifestation of neuromyelitis optica spectrum disorders (NMOSD) and diseases associated with myelin oligodendrocyte glycoprotein antibodies (MOGAD). In this paper, we present four clinical cases of atypical ON at the onset of NMOSD and MOGAD and illustrate the high diagnostic value of a multidisciplinary approach.

Spinal cord affection, according to various sources, is a common complication of a new coronavirus infection. The article describes various variants of spinal cord pathology in COVID-19, their potential mechanisms of development, approaches to treatment and outcomes of the disease. Three patients who were observed at the Research Center of Neurology and represent the most interesting cases of classic transverse myelitis, myelitis with predominant involvement of the lateral and posterior cords, and longitudinal widespread myelitis associated with antibodies to myelin oligodendrocyte glycoprotein (MOG) are considered in detail. These clinical observations demonstrate the importance of early diagnosis and selection of adequate therapy for a favorable outcome of the disease.

The diagnosis of multiple sclerosis (MS) is quite challenging due to its variable clinical manifestations and lack of a definitive test. Magnetic resonance imaging (MRI) is one of the tools to confirm the diagnosis and also helps in differential diagnosis with other disorders and in exclusion of MS-mimicking diseases. In this article, based on the analysis of clinical cases, we discuss the differential diagnosis of MS with the following non-tumorous multifocal brain lesions: vascular abnormalities caused by hypoxia and ischemia, cerebral autosomal dominant angiopathy with subcortical infarctions and leukoencephalopathy, Susac syndrome, primary angiitis of the central nervous system, and neurosarcoidosis. We present both MRI criteria for MS and disorders that have similar MRI signs, and additional clinical and laboratory data that is essential for correct diagnosis.

The diagnosis of multiple sclerosis (MS) is quite complicated, which is associated with its clinical features and the lack of unique confirmatory tests. Magnetic resonance imaging (MRI) is one of the ways to confirm the diagnosis and also makes it possible to establish a differential diagnosis with other demyelinating diseases and to exclude diseases that mimic MS. This review presents not only MRI criteria for MS and other diseases similar to the MRI pattern, but also additional clinical and laboratory data, without which it is impossible to make a correct diagnosis.

This article presents a clinical case of suboptimal response to multiple sclerosis therapy and an algorithm for treatment, taking into account the existing performance criteria.

Modern high-field MRI and multispiral CT machines enable notonly exploring structural changes in the central nervous system(CNS) but also evaluating cerebral blood flow, cerebral metabolicprocesses, and functional status of various brain regions. In thisarticle, we review state-of-the-art neuroimaging techniques suchas diffusion tensor imaging, susceptibility-weighted imaging,functional MRI, and MRI morphometry.The article provides abrief description of the physical principles of these techniques aswell as their application in research and clinical practice.

Motor disorders are a frequent syndrome in multiple sclerosis(MS), leading to severe disability, possibly associated with inefficiencyof adaptive mechanisms, probably because of widespreadstructural changes. Hand palsy with fine motor skillsdamage influences greatly on quality of life, because handfunction plays an important role in everyday activities andworking practices. Thus the aim of the study was to investigatefunctional and structural features of hand palsy in homogenoussample of MS patients during the relapse and in three months.Data were acquired from 25 relapsing-remitting MS patientsduring relapse also characterized by unilateral light hand palsy,and in three months. 12 age-matched healthy controls enteredthe control group. All patients underwent neurologica examination,including nine-hole peg test and dynamometry, andmagnetic resonance imaging of cervical spine and brain,including functional MRI and diffusion tensor imaging (DTI)sequences. All patients had lesions in spinal cord on cervicalspine MRI. fMRI data analysis during relapse showed differentlydirected activation changes and allowed to divide allpatients in two subgroups. These subgroups differed from eachother and control group by deep sensitivity and DTI values. Inthree months patients in the first subgroup had less completefine motor skills recovery, which was accompanied also bypreservation of activation changes and deep sensitivity asymmetryin comparison with the second subgroup. Received dataallow us to assume that clinically similar palsy, caused by spinalcord lesion, could be characterized by greater or lesser sensationimpairment contribution. In three months heterogeneousstructural and functional changes were observed, depending,possibly, on initially different pathologic mechanisms.Revealed differences should be taken into consideration whilerehabilitation planning.

Magnetic resonance imaging (MRI) is one of the main methodsof multiple sclerosis (MS) diagnostic, differential diagnostic anddisease course monitoring. Conventional MRI techniques havelow sensitivity in the assessment of diffuse damage of normalappearing white matter and focal/diffuse damage of grey matterwhich are of great interest in MS. Advanced MRI techniquesallow to get over these limitations and to obtain more specificinformation about MS pathogenesis. Thus MR-spectroscopymetabolites analysis helps to assess inflammation, myelin structure,remyelination and axonal loss or dysfunction, i.e. lets ussee pathochemical changes in MS. Demyelination and axonalloss differentiation is possible due to MR magnetization transfertechnique and also diffusion tensor imaging, which characterizewater diffusion in the brain tissue restricted by cell membranesand axonal cytoskeleton. Grey matter damage could be assessedusing sequences with one or two inverted impulses and morphometricanalysis of atrophy. Functional MRI performance usingdifferent paradigms characterizes cortical reorganization inresponse to functional injury. Vascular aspects of MS are alsowidely discussed nowadays. MR-perfusion and susceptibilityweighted imaging allow assessing perfusion and venous flowingchanges. State-of-the art neuroimaging methods let us performdetailed analysis of tissue damage in MS including the cell level,obtain more precise information about functional, metabolicand pathologic features, therapy influence on the inflammatoryreactions and neuroprotection. Perspective use of high-field MRscanners (more than 1.5 T) will lead to the increase of sensitivityof different pathologic mechanisms detection.

In this study, most characteristic clinical and neuroimaging features of different subtypes of ischemic stroke (IS), such as different evolution rates during an acute period of the disease, weredetermined. Despite the lack of differences in the final size of thelesion, more frequent hemorrhagic transformation and theregress of ischemic penumbra in patients with cardioembolicstroke during the first week may be regarded as the evidence of earlier recovery process in this subtype of IS. The obtained dataallowed elaborating an algorithm of application of different MRIregimens for brain visualization in the context of examinationand treatment of patients with acute IS.

Intravenous (i.v.) thrombolytic therapy of acute ischemic strokeis highly effective in selected group of patients. The most commoncomplications of systemic thrombolysis are intracerebralhaematomas, allergic reactions and acute hypotension. Theearly reocclusion/rethrombosis of intracranial arteries also mayinfluency the efficacy of thrombolysis. The clinical cases ofallergic reactions, acute hypotension and early reocclusion inthe first 24 hours after i.v. thrombolysis are described in the article.It is concluded that monitoring of neurological status andhaemodynamic parameters during and 24 hours after i.v. thrombolysisare the important factors of good outcome.

The problem of cerebral venous sinus thrombosis (CVT) stillstays in the focus of discussion due to the difficulties in diagnosticsand treatment as a result of the small incidence and the lackof specific symptoms. Currently there are not enough publicationsin the field of CVT. The article discusses issues of epidemiology,clinical signs, instrumental diagnostics and the treatmentof CVT.

Strategic trend in the treatment of acute stroke resulted from thrombosis or embolization of intracerebral arteries is reperfusion of the blood flow in the ischemic area thrombolysis. The modern methods of neuroimaging (CT and MR-angiography, diffusion and perfusion-weighted MRI, CT perfusion) play an important role in the thrombolysis decision making, as they allow to visualize the occlusion of the artery causing acute stroke, recanalization of the artery due to thrombolytic therapy,as well as the dynamics of the blood flow and metabolism in the respective brain regions. The presented clinical examples demonstrate the high efficacy of the thrombolytic treatment in acute ischemic stroke under the condition of absolute compliance with the inclusion and exclusion criteria to this therapy. The treatment of patients with acute stroke should be guided by the principles of evidence-based medicine and rely on adequate diagnostic algorithm of neuroimaging methods.

Hypertension is the main cause and the most important risk factorof various forms of temporary as well constant acute disturbancesof cerebral blood circulation. Patients with more than 25years hypertension and frequent increases of blood pressure havedamages of brain vessels with plasmorrhage and fibrinoid necrosis of capillaries walls. This damage in their turn being hypertonicstenosis or occlusion of brain vessels can lead to a disturbanceof blood flow in the supplied regions and result in formingsmall lacunar brain infarctions, the most typical for arterialhypertension. From the other hand, necrosis of media vesselsmyocytes can lead to their sharp thinning, forming microaneurysm,that breaks and causes intracerebral hemorrhage. Thepresented clinical observation states different types of hypertensionangiopathy in one patient and as a result different types ofdisturbances of cerebral blood circulation: cerebral hypertensionstroke, repeated intracerebral hemorrhage and small lacunarbrain infarctions.

Levamisole-associated multifocal inflammatory encephalopathy (LAMIE) is a devastating adverse effect of levamisole (LEV) treatment. In Russia, people often use LEV without a doctor's prescription for anthelmintic prophylaxis. LAMIE often misdiagnosed as the first episode of MS or acute disseminated encephalomyelitis (ADEM). The aim of our study was to describe clinical, laboratory and morphological characteristics of LAMIE, magnetic resonance imaging (MRI) patterns and create an algorithm for the differential diagnosis. This study was a prospective observational study with retrospective analysis of cases. It was performed at two hospitals with ambulatory service for MS. We included 43 patients with LAMIE with follow-up was from 1 year to 5 years. Age was 19-68 y.o. with female predominance. The most typical manifestations of LAMIE were cerebellar, pyramidal and cognitive symptoms, and majority of patients had biphasic course of the disease. Three main types of MRI patterns were described: ADEM-like, MS-like, atypical demyelination. About 40% of patients had CSF specific oligoclonal bands synthesis, but only 20 % of them converted to MS during the period from 1 month until 2 years. The CSF albumin levels and immunoglobulin G index were elevated in LAMIE patients compared to reference values. We described results of brain biopsy in two cases. Therefore LAMIE should be considered in patients with demyelinating or inflammatory conditions with biphasic onset of the disease and variable MRI presentation., Competing Interests: Declaration of Competing Interest None., (Copyright © 2022 Elsevier B.V. All rights reserved.)