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Publication Detail
A model for interrogating the clinico-radiological paradox in multiple sclerosis: internuclear ophthalmoplegia.
BACKGROUND: The clinico-radiological paradox in MS is well recognised, relevant and yet poorly understood. We tested the suitability of an in vivo model for the clinico-radiological paradox, using internuclear ophthalmoplegia (INO) and the medial longitudinal fasciculus (MLF). METHOD: In this cross-sectional study lesions of the MLF were rated by an experienced MS neuroradiologist blinded to all other information. Presence of an INO was objectively determined by a validated infrared oculography protocol (DEMoNS). Clinical information, amongst which the National Eye Institute Visual Function Questionnaire (NEI-VFQ-25), was obtained. RESULTS: This study included 202 patients with MS. The clinico-radiological paradox occurred in 50 patients (25%). This consisted of 45 patients having an INO without a MLF lesion, and 5 patients with a MLF lesion but without an INO. The visual function overall score was related to presence of an INO (p=0.016), but not to MLF lesions seen on MRI (p=0.207). A consensus list of potential causes for the clinico-radiological paradox was compiled and the MRI images were deposited in an open access repository. CONCLUSION: This study provides an objective and quantitative model to investigate the clinico-radiological paradox. Our data suggest that pathology of the MLF is more frequently detected and more clinically relevant by infrared oculography than by MLF lesion rating on MRI.
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