The use of brain magnetic resonance imaging (MRI) for evaluation of neurological disorders has increased in the past two decades. This has led to an increased detection of incidental findings on brain MRI. The most common of these asymptomatic abnormalities are white matter lesions that are interpreted as demyelinating based on radiological criteria. However, in the absence of associated clinical symptoms suggestive of multiple sclerosis (MS), a definite diagnosis of MS cannot be made in patients with these incidental white matter lesions. These patients are now diagnosed as radiologically isolated syndrome (RIS). The natural history and clinical approach to patients with RIS are reviewed in this article.

Background Because of the high degree of disability in multiple sclerosis (MS) patients, minimizing injury occurrence is essential for preserving quality of life. Objectives By documenting the incidence of particular injuries, establishing relative risks of particular injuries in different subsets of MS patients and analyzing when the injuries occurred following diagnosis, we aim to provide information to encourage injury prevention recommendations and to provide preliminary data for further clinical research. Methods This study utilized a questionnaire consisting of 40 fill-in-the-blank or multiple choice questions. It was administered to previously diagnosed MS patients at office visits, infusion center visits, hospital stays, MS clinic visits and MS support groups. Results The years following definite MS diagnosis with the highest injury rates (injuries/people years lived) were 25 years or more (.0594 injuries/year, 95% CI [0.0771 - 0.0449]). In addition, people below the age of 40 have nearly a doubled risk of injury compared to people above the age of 40 (p= .033). Primary progressive MS patients had the greatest past incidence of fractures, 55.6% (5/9) (p=0.033). Patients reported that only 17.4% (19/109) of injuries occurred during exercise. Conclusions Overall, risk factors for injury include male gender, living longer with MS, being younger and having the diagnosis of primary progressive MS. Patient education, along with specific treatments and regimented physical activity, can lead to a more robust and injury free lifestyle in this patient population.

Background Anticoagulation with warfarin is an important therapy for preventing strokes in patients with atrial fibrillation (AF). Physicians often combine warfarin with aspirin despite evidence for increased bleeding. We investigated the hemorrhagic outcomes related to the differential management of AF with warfarin alone versus combination therapy. Methods and Results This retrospective cohort study of 695 patients enrolled at a university hospital-based anticoagulation clinic includes patients who received anticoagulation with warfarin or warfarin and aspirin between June 1, 2007 and September 30, 2008. All patients were ≥45 years old, had AF as the indication for anticoagulation, and did not have mechanical heart valves. Hemorrhages were classified as major if they caused death, involved critical sites, or required hospitalization with transfusion of ≥2 units of blood. All other bleeds were classified as minor. Of the 695 patients 307(44.2%) received combination therapy. Hemorrhage rates in the warfarin and the combination cohorts were 5.2% and 7.0% per 100-people years (p=0.29), respectively. There were 17 (3.4%) patients with major hemorrhages in the warfarin only group and 9 (2.8%) in the combination group (p=0.62). On average, patients on combination therapy had lower international normalized ratio (INR) values circa presentation (4.27 vs 3.13 p=0.049). In either group, any history of hemorrhage was associated with a 3.8 (95% CI, 1.79-8.13) times higher risk of hemorrhaging compared to patients without such a history. Conclusions This study highlights the high incidence of combination therapy and suggests that patients on combination therapy may bleed at lower INR levels. However, hemorrhagic outcomes did not differ significantly.