Multiple Sclerosis and the Choroid Plexus: Emerging Concepts
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The coexistence of multiple sclerosis and intracranial neoplasms is very rare, and whether this occurrence can be explained by a causal relationship or by coincidence remains a matter of debate. Possible roles of the choroid plexus as a site of tumor cell invasion and lymphocyte infiltration into the central nervous system have been hypothesized in recent studies.

Here, a case of 13-year-old right-handed boy presented with a one-month history of left facial weakness and numbness associated with a bitemporal headache.

His neurological examination was unremarkable with the exception of left facial numbness. Magnetic resonance imaging (MRI) of the brain performed on a 3.0-T magnet with and without contrast showed a few small, nonenhancing periventricular, juxtacortical, and pontine T2/fluid-attenuated inversion recovery hyperintensities that were deemed nonspecific at the time , in addition to a left-sided 0.8 cm homogeneously enhancing nodule at the level of the fourth ventricle and foramen of Magendie inferior to the facial colliculus, which was surgically removed. An entire spine MRI performed with and without contrast was normal. Microscopic examination revealed a choroid plexus papilloma (World Health Organization grade I) . The patient’s symptoms resolved after surgery.

Three months after discharge, a follow-up MRI of the brain showed stable postoperative changes in the posterior fossa and stable small, nonenhancing periventricular, juxtacortical, and pontine T2/fluid-attenuated inversion recovery hyperintensities , in addition to a new enhancing lesion in the right periatrial region . At that time, the patient was referred to the outpatient neurology clinic, and a diagnosis of MS was made on the basis of MRI lesion dissemination in space and the 2017 McDonald criteria. His family history was significant for anticardiolipin syndrome in his mother and Crohn disease in a maternal cousin. On further questioning, the patient reported a four-day history of numbness in the right side of his face and arm.

The CSF opening pressure was normal. He was treated with a five-day course of daily intravenous methylprednisolone 30 mg/kg, followed by a tapering dose of oral steroids. After discussion with the patient and the family, long-term immunosuppression with glatiramer acetate was initiated.

In conclusion, multiple sclerosis the choroid plexus could act as a gateway for lymphocyte entry from the peripheral blood into the central nervous system at its earlier stages. However, future studies are needed to identify whether structural alterations of the choroid plexus play a role in the pathophysiology of multiple sclerosis and to provide suitable models to determine their consequences.

Source: https://www.sciencedirect.com/science/article/pii/S0887899419304990
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