Central vein sign and paramagnetic rim lesions can aid in an earlier diagnosis of late-onset multiple sclerosis and may circumvent the need for biopsy. Learn more in this Pearls & Oy-sters article.

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CSF analysis revealed lymphocytic pleocytosis (41 total nucleated cells [normal 0–5/μL], 98% lymphocytes) and an elevated protein of 89 mg/dL (normal, 0–35 mg/dL) without hypoglycorrhachia. CSF kappa free light chains (KFLC) and IgG index were not elevated, and CSF-specific oligoclonal bands (OCBs) were absent. CSF cytology and flow cytometry were negative for malignancy. Extensive neural antibody testing was negative including serum aquaporin-4-immunoglobulin G, myelin oligodendrocyte glycoprotein-immunoglobulin G, and CSF glial fibrillary acidic protein antibody. Extensive rheumatological and infectious testing was also negative. Neurofilament light chain was elevated to 188 pg/mL (normal ≤19 pg/mL for age 60–65 years). Whole body PET was negative, and optical coherence tomography was normal.

Owing to concerns for neurosarcoidosis, lymphoma, or vasculitis, a percutaneous stereotactic biopsy of a right occipital lesion was performed. Pathology revealed a demarcated CD68/163+ macrophage-rich lesion with myelin loss, relative axonal preservation, and a CD3⁺ predominant lymphocytic infiltrate with rare CD20⁺ B cells, consistent with active demyelination (Figure 2). She initiated a 5-day course of high-dose oral prednisone (1,250 mg daily) followed by a taper. Within 2 days of treatment, she experienced mild improvement in dysarthria and ataxia, although her EDSS score remained 6 on discharge.

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Infants born with congenital heart disease (CHD) often have neurodevelopmental impairments that affect them later in life, including their ability to regulate their emotions and movements. As CHD is the most prevalent congenital disorder in the United States, researchers are eager to find new ways to treat it.

To better understand how CHD affects an infant’s developing nervous system, researchers at Children’s National Hospital used resting-state functional magnetic resonance imaging (rs-fMRI) to evaluate how healthy infants and those with CHD differed. They recently reported in the Journal of Neuroscience that babies with CHD had altered brain activity in their sensorimotor and limbic networks, but after neonatal heart surgery, these brain networks looked more like those of healthy children.

“Using fMRI, we can identify brain networks that are vulnerable to altered oxygen and blood flow from congenital heart disease, which could help guide interventions to improve care for children,” said Jung-Hoon Kim, a brain researcher at Children’s National Hospital and a coauthor of the study, in a press release.

In their study, the researchers analyzed rs-fMRI data from 448 neonates. They first analyzed publicly available data from the Developing Human Connectome Project, which contains a large amount infant brain development MRI data.3 They identified 15 different resting state networks, which represented different regions of brain activity, in the healthy neonate brains.

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Babies with congenital heart disease have altered brain activity in regions involved in movement and emotions, but heart surgery restored these brain networks to healthy connectivity.

Surgeries are increasingly opening patients’ brains to research. But the opportunities that come with this intimate access also raise complex ethical issues.

Learn more during BrainAwarenessWeek.

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Invasive treatments give scientists an intimate view of neural activity, but ethicists worry about mixing research and medical care.