Detection of brainstem lesions in multiple sclerosis: comparison of brainstem auditory evoked potentials with nuclear magnetic resonance imaging

Abstract

Topographical information provided by brainstem auditory evoked potentials (BAEPs) was investigated in 43 patients by comparison with cerebral nuclear magnetic resonance imaging (NMR). Lesions in the region of the brainstem auditory pathways were demonstrated by BAEPs in 44.2%, and in 39.5% by NMR. As regards brainstem levels, in 15/21 (71.4%) with abnormal findings at least one lesion was verified by NMR-matched BAEP results. The study confirms the topographical information provided by the BAEPs on the different levels of the brainstem, but not the assumption that generation of the BAEPs is predominantly ipsilateral. BAEPs retain their importance for the detection of disseminated lesions in the diagnosis of multiple sclerosis (MS) in the era of expensive imaging methods.

Brain Stem Magnetic Resonance Imaging and Evoked Potential Studies of Symptomatic Multiple Sclerosis Patients

“…The preva lence of BAEP and mSEP abnormalities found in this study is similar to the results in previous reports [3,4,[6][7][8], The lesser sensitivity of EPs than of MRI can be explained by the relatively high anatomic specificity of these tests which analyze BS acoustic pathways and the medial lemniscus. The use of a more extensive battery of neurophysiological techniques, such as electronystagmographic examination, blink reflex, or trigeminal SEP. could probably produce greater sensitivity of neurophysi ological evaluation, as reported by other groups [24][25][26], Our patients had a variety of clinical signs suggestive of focal involvement of BS structures, but in most cases the clinical features cannot be definitely referred to welllocalized lesions.…”

“…The lower values of BS MRI abnormalities reported in previous papers [6][7][8]10] can be essentially explained by technical difficulties. Several factors may have contrib uted to our positive results: the thickness of the slice, the strength of the field, the combined examination of sagittal and axial planes, and the use of the GMR technique.…”

“…Clinical signs of brain stem (BS) dysfunction are de tectable in the majority of clinically definite multiple scle rosis (MS) patients, and they are the onset manifestation Some studies demonstrated that BS auditory EPs (BAEPs) were more sensitive than MRI in detecting BS lesions [7,8]. Combined use of BAEPs and median soma tosensory EPs (mSEPs) further increased the sensitivity of EPs [6].…”

The Use of Brain Magnetic Resonance Imaging in Multiple Sclerosis

“…The au¬ thors performed brain computed tomog¬ raphy (CT) with and without contrast, and unenhanced brain MRI scans on 10 patients with clinically definite MS (CDMS) . 4 They found 19 periventricular lesions by means of CT scan. All 19 periventricular lesions were also visualized with T2-weighted MRI images, but an additional 112 lesions dis¬ tributed in the periventricular, deep white matter, gray-whitejunction, and the brain-stem regions were visualized by MRI.…”

“…Mariani et al66 reported that 19 The authors found that MS patients with MRI lesions showed a higher CSF IgG concentration, higher number ofCSF plasma cells, and were more likely to have oligoclonal bands com¬ pared with those patients without MRI lesions. Addition¬ ally, there was a higher percentage of peripheral blood cells expressing light chains in patients with abnormal MRI com¬ pared with control subjects.…”