Leptomeningeal enhancement in multiple sclerosis and other neurological diseases: A systematic review and Meta-Analysis

Ineichen, Benjamin Victor; Tsagkas, Charidimos; Absinta, Martina; Reich, Daniel S.

doi:10.1016/j.nicl.2022.102939

Cited by 40 publications

(44 citation statements)

References 55 publications

(118 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Not included in the PSR but presented for completeness is an systematic review of MRI LM enhancement (LME) of the brain in multiple sclerosis and other neuroinflammatory diseases e-published prior to print January 2022 [945]. DLMs were not specifically included.…”

Section: Diagnostic Studies For Dlmsmentioning

confidence: 99%

The leptomeninges as a critical organ for normal CNS development and function: First patient and public involved systematic review of arachnoiditis (chronic meningitis)

Palackdkharry¹,

Wottrich²,

Dienes³

et al. 2022

PLoS ONE

View full text Add to dashboard Cite

Background & importance This patient and public-involved systematic review originally focused on arachnoiditis, a supposedly rare “iatrogenic chronic meningitis” causing permanent neurologic damage and intractable pain. We sought to prove disease existence, causation, symptoms, and inform future directions. After 63 terms for the same pathology were found, the study was renamed Diseases of the Leptomeninges (DLMs). We present results that nullify traditional clinical thinking about DLMs, answer study questions, and create a unified path forward. Methods The prospective PRISMA protocol is published at Arcsology.org. We used four platforms, 10 sources, extraction software, and critical review with ≥2 researchers at each phase. All human sources to 12/6/2020 were eligible for qualitative synthesis utilizing R. Weekly updates since cutoff strengthen conclusions. Results Included were 887/14286 sources containing 12721 DLMs patients. Pathology involves the subarachnoid space (SAS) and pia. DLMs occurred in all countries as a contributor to the top 10 causes of disability-adjusted life years lost, with communicable diseases (CDs) predominating. In the USA, the ratio of CDs to iatrogenic causes is 2.4:1, contradicting arachnoiditis literature. Spinal fusion surgery comprised 54.7% of the iatrogenic category, with rhBMP-2 resulting in 2.4x more DLMs than no use (p<0.0001). Spinal injections and neuraxial anesthesia procedures cause 1.1%, and 0.2% permanent DLMs, respectively. Syringomyelia, hydrocephalus, and arachnoid cysts are complications caused by blocked CSF flow. CNS neuron death occurs due to insufficient arterial supply from compromised vasculature and nerves traversing the SAS. Contrast MRI is currently the diagnostic test of choice. Lack of radiologist recognition is problematic. Discussion & conclusion DLMs are common. The LM clinically functions as an organ with critical CNS-sustaining roles involving the SAS-pia structure, enclosed cells, lymphatics, and biologic pathways. Cases involve all specialties. Causes are numerous, symptoms predictable, and outcomes dependent on time to treatment and extent of residual SAS damage. An international disease classification and possible treatment trials are proposed.

show abstract

Section: Diagnostic Studies For Dlmsmentioning

confidence: 99%

The leptomeninges as a critical organ for normal CNS development and function: First patient and public involved systematic review of arachnoiditis (chronic meningitis)

Palackdkharry¹,

Wottrich²,

Dienes³

et al. 2022

PLoS ONE

View full text Add to dashboard Cite

show abstract

“…However, recent studies showed that claudin 11, a TJ protein enriched in the arachnoid barrier, is downregulated in EAE mice ( Uchida et al, 2019 ), indicating a disruption of the arachnoid BCSFB. Increased permeability of the leptomeningeal vessels has also been shown in MRI studies in several brain disorders, including stroke, CNS infections and cerebral amyloid angiopathy ( Ineichen et al, 2022 ). Leptomeninges are now recognized as key players in the development of MS and EAE ( Pikor et al, 2015 ; Russi and Brown, 2015 ; Rua and McGavern, 2018 ; Wicken et al, 2018 ).…”

Section: Neutrophil Contribution To Meningeal Inflammationmentioning

confidence: 90%

The role of neutrophils in the dysfunction of central nervous system barriers

Santos-Lima

Pietronigro

Terrabuio

et al. 2022

Front. Aging Neurosci.

View full text Add to dashboard Cite

Leukocyte migration into the central nervous system (CNS) represents a central process in the development of neurological diseases with a detrimental inflammatory component. Infiltrating neutrophils have been detected inside the brain of patients with several neuroinflammatory disorders, including stroke, multiple sclerosis and Alzheimer’s disease. During inflammatory responses, these highly reactive innate immune cells can rapidly extravasate and release a plethora of pro-inflammatory and cytotoxic factors, potentially inducing significant collateral tissue damage. Indeed, several studies have shown that neutrophils promote blood-brain barrier damage and increased vascular permeability during neuroinflammatory diseases. Recent studies have shown that neutrophils migrate into the meninges and choroid plexus, suggesting these cells can also damage the blood-cerebrospinal fluid barrier (BCSFB). In this review, we discuss the emerging role of neutrophils in the dysfunction of brain barriers across different neuroinflammatory conditions and describe the molecular basis and cellular interplays involved in neutrophil-mediated injury of the CNS borders.

show abstract

“…The demonstration of superficial cerebral vein tortuosity contrasts with the pattern of leptomeningeal enhancement that may present in neoplastic or infectious neurological diseases. 1 The brain parenchyma was of normal signal intensity on all conventional MRI sequences without focal abnormalities.…”

Section: Descriptionmentioning

confidence: 91%

Unusual neuroimaging features in a patient with chromosome 11q14.1–11q23.2 deletion

Lai²,

Crawford

2022

BMJ Case Rep

View full text Add to dashboard Cite

Leptomeningeal enhancement in multiple sclerosis and other neurological diseases: A systematic review and Meta-Analysis

Cited by 40 publications

References 55 publications

The leptomeninges as a critical organ for normal CNS development and function: First patient and public involved systematic review of arachnoiditis (chronic meningitis)

The leptomeninges as a critical organ for normal CNS development and function: First patient and public involved systematic review of arachnoiditis (chronic meningitis)

The role of neutrophils in the dysfunction of central nervous system barriers

Unusual neuroimaging features in a patient with chromosome 11q14.1–11q23.2 deletion

Contact Info

Product

Resources

About