{"id":233557,"date":"2026-03-18T02:33:40","date_gmt":"2026-03-18T07:33:40","guid":{"rendered":"https:\/\/lifeboat.com\/blog\/2026\/03\/pearls-oy-sters-using-susceptibility-based-imaging-in-highly-active-late-onset-multiple-sclerosis"},"modified":"2026-03-18T02:33:40","modified_gmt":"2026-03-18T07:33:40","slug":"pearls-oy-sters-using-susceptibility-based-imaging-in-highly-active-late-onset-multiple-sclerosis","status":"publish","type":"post","link":"https:\/\/lifeboat.com\/blog\/2026\/03\/pearls-oy-sters-using-susceptibility-based-imaging-in-highly-active-late-onset-multiple-sclerosis","title":{"rendered":"Pearls &amp; Oy-sters: Using Susceptibility-Based Imaging in Highly Active Late-Onset Multiple Sclerosis"},"content":{"rendered":"<p><a class=\"aligncenter blog-photo\" href=\"https:\/\/lifeboat.com\/blog.images\/pearls-oy-sters-using-susceptibility-based-imaging-in-highly-active-late-onset-multiple-sclerosis2.jpg\"><\/a><\/p>\n<p>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 &amp; Oy-sters article.<\/p>\n<hr>\n<p>CSF analysis revealed lymphocytic pleocytosis (41 total nucleated cells [normal 0\u20135\/\u03bcL], 98% lymphocytes) and an elevated protein of 89 mg\/dL (normal, 0\u201335 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 \u226419 pg\/mL for age 60\u201365 years). Whole body PET was negative, and optical coherence tomography was normal.<\/p>\n<p>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<sup>+<\/sup> predominant lymphocytic infiltrate with rare CD20<sup>+<\/sup> B cells, consistent with active demyelination (<a href=\"https:\/\/www.neurology.org\/doi\/10.1212\/WNL.0000000000214794#F2\">Figure 2<\/a>). 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.<\/p>\n<p>Open in Viewer.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>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 &amp; Oy-sters article. CSF analysis revealed lymphocytic pleocytosis (41 total nucleated cells [normal 0\u20135\/\u03bcL], 98% lymphocytes) and an elevated protein of 89 mg\/dL (normal, 0\u201335 mg\/dL) [\u2026]<\/p>\n","protected":false},"author":662,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[11,47],"tags":[],"class_list":["post-233557","post","type-post","status-publish","format-standard","hentry","category-biotech-medical","category-neuroscience"],"_links":{"self":[{"href":"https:\/\/lifeboat.com\/blog\/wp-json\/wp\/v2\/posts\/233557","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/lifeboat.com\/blog\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/lifeboat.com\/blog\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/lifeboat.com\/blog\/wp-json\/wp\/v2\/users\/662"}],"replies":[{"embeddable":true,"href":"https:\/\/lifeboat.com\/blog\/wp-json\/wp\/v2\/comments?post=233557"}],"version-history":[{"count":0,"href":"https:\/\/lifeboat.com\/blog\/wp-json\/wp\/v2\/posts\/233557\/revisions"}],"wp:attachment":[{"href":"https:\/\/lifeboat.com\/blog\/wp-json\/wp\/v2\/media?parent=233557"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/lifeboat.com\/blog\/wp-json\/wp\/v2\/categories?post=233557"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/lifeboat.com\/blog\/wp-json\/wp\/v2\/tags?post=233557"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}