Comparison of neurosensorial, neurophysiological and magnetic resonance imaging findings in patients with multiple sclerosis and clinically isolated syndromes with brainstem involvement

Objective: Brainstem structures frequently involved in the initial and course of MS.Patients with brainstem involvement are more likely to develop persistent disabilitythan patients without brainstem involvement. In the present study we aimed to applylateralization and localisation of lesion through detailed neuroophtalmological andneurootological assessment, to assess the correlation of pathological findings whichwere identified through brain stem auditory-evoked potential (BAEP) and brainmagnetic resonance imaging (MRI) and to identify its contribution to diagnosis.Material and Methods: In our study, we included 17 patients who experienced thefirst brainstem relapse (7 CIS and 10 RRMS), 19 patients with brainstem involvementand sequel brainstem symptoms and 13 age and sex matched healty subjects. Allsubjects were applied neurological, and detailed neuroophtalmological andneurootological examination, as well as BAEP analysis and brain MRI in 3 and 4 mmbrainstem sections ( T2 lesion, lesion contrast enhancement, brainstem volumemeasurement).Results: In 4 mm brainstem sections, 80 % of patients had brainstem MRI pathology.In those with 3 mm sections, 82.9 % patients had brainstem MRI lesions. In thewhole patient group 66,6 % of patients had BAEP pathology. In MS patients groupwith brainstem involvement, rate of pathology in MRI was significantly highercomparing to BAEP (p=0.012). Brainstem volume was found to be significantly lowerin choronical patients comparing with control group and acute patients (p=0.001,p=0.008). No difference was found in volume measurement between CIS and controlgroup. It was determined that among CIS patients, brain stem volume was found tobe significantly lower in patients with higher EDSS scores than those with lowerscores (p=0.008). Brainstem volume was found to be significantly lower in RRMSgroup than controls (p=0.017). It was also significantly lower in SPMS group thancontrols, CİS, RRMS group, brainstem volume was found to be (p=0.001, p=0.005 ,p=0.014).Conclusion: In terms of determining brainstem involvement, MRI found to be moresensitive than BAEP. For localization of clinical findings BAEP had statisticalsignificant superiority. Although decreased brainstem volume was found even in theearly period of the illness, the patients had chronical diease the more the brainstemvolume decreased.Key words : Multiple sclerosis (MS), brainstem auditory-evoked potentials (BAEP)magnetic resonance Imaging (MRI), brainstem volume.