Do these lesions look like MS?

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Do these lesions look like MS?

Postby Anonymoose » Fri Jan 25, 2013 3:46 pm

Image
Larger image here http://archneur.jamanetwork.com/data/Jo ... 0319f2.png

The MRI image on the left is of a patient with salt-wasting congenital adrenal hyperplasia (CAH). Almost from birth, people with this condition have to be treated with hydrocortisone and aldosterone. They cannot produce cortisol or aldosterone on their own. So, if they are given just a bit too much aldosterone for their whole lives, could that be what causes these MS-like lesions in salt-wasting CAH? These lesions are not present in MRIs of CAH patients without the salt-wasting form of the disease (can be seen at 1st link below). Excess aldosterone=>MS lesions??

CAH is thought to be somehow linked to MS.
http://archneur.jamanetwork.com/article ... qundefined

One patient with the salt-wasting form of CAH in study above developed MS.
http://www.ncbi.nlm.nih.gov/pubmed/15596619
Last edited by Anonymoose on Fri Jan 25, 2013 8:04 pm, edited 1 time in total.
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Re: Do these lesions look like MS?

Postby euphoniaa » Fri Jan 25, 2013 4:55 pm

Well, Anonymoose, I don't think those MRIs look anything like mine, and mine were so obviously MS lesions that I got a definite dx the day after my first MRI. I think I look fascinating without my skull! :smile: Check it out.

Image

Image
Dx'd with MS & HNPP (hereditary peripheral neuropathy) 7/03 but must have had MS for 30 yrs before that. I've never taken meds for MS except 1 yr experiment on LDN. (I found diet, exercise, sleep, humor, music help me the most.)
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Re: Do these lesions look like MS?

Postby Anonymoose » Fri Jan 25, 2013 5:10 pm

Ooo! You've got some good ones. (Pretend we are 12 year old boys comparing scabs.)

I've only got about half a dozen lesions and they look like the lesions in the salt-wasting CAH MRI...except one that is about like the one you have in the upper right side of your very impressive brain. I got the diagnosis the day after my MRI too. Do you think the bigger ones are a bunch of little ones clumped together?

You look better without a skull than I do. :)
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Re: Do these lesions look like MS?

Postby Anonymoose » Fri Jan 25, 2013 8:03 pm

Whoops!

I read on this page that the salt-wasting form of CAH has to be treated with aldosterone.
http://www.vivo.colostate.edu/hbooks/pa ... l/cah.html

But, a lot of the studies I am reading don't list aldosterone as part of the treatment and sometimes say that the patients are treated with glucocorticoids and salt. Soooo...maybe the glucocorticoids (cortisol-like) cause the lesions... :roll:
http://www.sciencedirect.com/science/ar ... 9811000870
Glucocortioids affect several cellular structures and functions, which may explain the observed adverse effects. Glucocorticoids can impair neuronal glucose uptake, decrease excitability, cause atrophy of dendrites, compromise development of myelin-producing oligodendrocytes and disturb important cellular structures involved in axonal transport, long-term potentiation and neuronal plasticity.


Also, the image on the left above is salt-wasting CAH. The one on the right isn't.
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Re: Do these lesions look like MS?

Postby Anonymoose » Sat Jan 26, 2013 5:09 pm

Full case report of abstract listed above for ms/cah patient.
http://archneur.jamanetwork.com/article ... qundefined
Therefore, we can speculate that the co-occurrence of CAH and central nervous system demyelination could in fact be nonrandom. First, validation of this alternative hypothesis would depend on a plausible reason as to why the CAH-MS co-occurrence has been described in only one case and why all the previous CAH patients with white matter abnormalities, perhaps interpretable as demyelinating lesions, had no clinical neurological signs. A possible explanation derives from the interplay between MS-inducing immunopathological processes and the particular “hormonal environment” that characterizes CAH patients. These latter patients are indeed exposed before and after birth to high levels of dehydroepiandrosterone and progesterone, which can have anti-inflammatory effects and a protective role for myelin.7- 8 The dual-signal hypothesis on MS pathogenesis holds that 2 concomitant (but possibly unrelated) inflammatory events, respectively occurring in the central nervous system and in the periphery, constitute the crucial elements in the disease’s development.9 Accordingly, in those CAH patients who are prone to develop MS, hormonal factors could modulate the peripheral MS-promoting autoimmune events and prevent these patients from exceeding the clinical threshold of the disease. In this scenario, the patients could show only mild pathological signs, not overt clinical manifestations.

I can't find any autopsy studies of the CAH brain lesions. Apparently they are more intrigued by CAH testicular lesions. :roll:
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Re: Do these lesions look like MS?

Postby civickiller » Sat Jan 26, 2013 6:15 pm

the 2 mri pics for Anonymoose and euphoniaa both have scaring around the ventricles suggesting csf leakage so a blockage somewhere which is usually at the C1 and/or C2 levels in your spine
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Re: Do these lesions look like MS?

Postby Anonymoose » Tue Jan 29, 2013 8:11 am

Thanks civic...but that's not my brain! lol Comment still relevant though. Thank you.

You know what salt-wasting CAH and MS have in common besides cute little lesions? NA:K imbalance. CAH would have too much potassium as aldosterone is what causes the body to excrete it...no aldosterone, no potassium excretion. MSer's would have too much NA as aldosterone causes it to be hoarded while it tosses out all the potassium.

I'm going on a witch hunt for BBB failure caused by this imbalance. I bet I won't find it in a nice little abstract, but I'll glue another sloppy theory/hypothesis/guess together somehow.
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Re: Do these lesions look like MS?

Postby Tatyana » Mon Feb 04, 2013 4:04 am

civickiller wrote:the 2 mri pics for Anonymoose and euphoniaa both have scaring around the ventricles suggesting csf leakage so a blockage somewhere which is usually at the C1 and/or C2 levels in your spine


CSF is black in the type of MRI scan shown in euphoniaa's post so it's definitely not any sort of leakage.
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