The spectrum of psychosis in multiple sclerosis: a clinical case series

Psychosis in the context of multiple sclerosis (MS) has previously been reported as a rare occurrence. However, recent epidemiological studies have found prevalence rates of psychosis in MS that are two to three times higher than those in the general population. Untreated psychosis in patients with MS can adversely impact on adherence to MS medication, levels of disability, and quality of life. This retrospective case series describes the spectrum of psychotic disorders occurring in association with MS using demographic, clinical, and neuroimaging data. In the discussion, we highlight the particular diagnostic and treatment challenges that such disorders can pose for clinicians and through our case vignettes provide examples of potential interventions for this complex patient population

Tuberculous orbital apex syndromes.

AIMS: To describe the clinical and radiological features of orbital apex syndromes caused by presumed tuberculosis (TB). METHODS: A review of the discharge summaries of all patients seen in the Medical Eye Unit (MEU), St Thomas' Hospital between 1975 and 2006 identified seven patients with a diagnosis of orbital apex syndrome or optic neuropathy attributable to TB. Case notes and radiology were reviewed retrospectively for each patient. RESULTS: All of the patients were born outside the UK and were HIV-negative. Four presented during 2005-6. Six of the seven patients presented with a visual acuity (VA) of less than counting fingers (CF), but all achieved a VA of 6/9 or better after a median 3 weeks of treatment with antituberculous treatment and systemic corticosteroids. All patients had constitutional symptoms. Chest x ray and CSF were normal in each case, but MRI was abnormal in six. CONCLUSIONS: We report a recent cluster of tuberculous orbital apex syndromes, in the context of an increasing incidence of TB in the UK. The condition is difficult to diagnose, but the combination of high-dose corticosteroids and anti-TB medication was rapidly effective and achieved a good outcome in all cases

The spectrum of psychosis in multiple sclerosis: a clinical case series

Thomas G Gilberthorpe,1 Kara E O’Connell,2,3 Alison Carolan,1 Eli Silber,4 Peter A Brex,4 Naomi A Sibtain,4 Anthony S David3 1Department of Liaison Psychiatry, South London and Maudsley NHS Foundation Trust, Maudsley Hospital, London, UK; 2Department of Psychiatry, School of Medicine, Trinity College Dublin, Ireland; 3Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, 4Department of Neurology, Kings College Hospital, London, UK Abstract: Psychosis in the context of multiple sclerosis (MS) has previously been reported as a rare occurrence. However, recent epidemiological studies have found prevalence rates of psychosis in MS that are two to three times higher than those in the general population. Untreated psychosis in patients with MS can adversely impact on adherence to MS medication, levels of disability, and quality of life. This retrospective case series describes the spectrum of psychotic disorders occurring in association with MS using demographic, clinical, and neuroimaging data. In the discussion, we highlight the particular diagnostic and treatment challenges that such disorders can pose for clinicians and through our case vignettes provide examples of potential interventions for this complex patient population. Keywords: psychosis, multiple sclerosis, neuropsychiatric, cognitive, schizophrenia-like, demyelinatio

Magnetic resonance spectroscopy and imaging on fresh human brain tumor biopsies at microscopic resolution

[EN] The metabolic compn. and concn. knowledge provided by magnetic resonance spectroscopy (MRS) liq. and high-resoln. magic angle spinning spectroscopy (HR-MAS) has a relevant impact in clin. practice during magnetic resonance imaging (MRI) monitoring of human tumors. In addn., the combination of morphol. and chem. information by MRI and MRS has been particularly useful for diagnosis and prognosis of tumor evolution. MRI spatial resoln. reachable in human beings is limited for safety reasons and the demanding necessary conditions are only applicable on exptl. model animals. Nevertheless, MRS and MRI can be performed on human biopsies at high spatial resoln., enough to allow a direct correlation between the chem. information and the histol. features obsd. in such biopsies. Although HR-MAS is nowadays a well-established technique for spectroscopic anal. of tumor biopsies, with this approach just a mean metabolic profile of the whole sample can be obtained and thus the high histol. heterogeneity of some important tumors is mostly neglected. The value of metabolic HR-MAS data strongly depends on a wide statistical anal. and usually the microanatomical rationale for the correlation between histol. and spectroscopy is lost. We present here a different approach for the combined use of MRI and MRS on fresh human brain tumor biopsies with native contrast. This approach has been designed to achieve high spatial (18 × 18 × 50 m) and spectral (0.031 L) resoln. in order to obtain as much spatially detailed morphol. and metabolical information as possible without any previous treatment that can alter the sample. The preservation of native tissue conditions can provide information that can be translated to in vivo studies and addnl. opens the possibility of performing other techniques to obtain complementary information from the same sample.The authors acknowledge the SCSIE-University of Valencia Microscopy Service for the histological preparations. They also acknowledge financial support from the Spanish Government project SAF2007-6547, the Generalitat Valenciana project GVACOMP2009-303, and the E.U.s VI Framework Program via the project "Web accessible MR decision support system for brain tumor diagnosis and prognosis, incorporating in vivo and ex vivo genomic and metabolomic data" (FP6-2002-LSH 503094).Martínez-Bisbal, M.; Martínez-Granados, B.; Rovira, V.; Celda, B.; Esteve, V. (2015). Magnetic resonance spectroscopy and imaging on fresh human brain tumor biopsies at microscopic resolution. 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