Article Figures & Data
Figures
- FIG 1.
A, Axial T2-weighted image in a 21-year-old patient presenting to the emergency department with the worst headache of her life shows left periventricular posterior fossa lesions (arrow). B, The FLAIR scan demonstrates periventricular (Dawson fingers-like) and juxtacortical lesions (arrows). C, None of the lesions show gadolinium enhancement.
- FIG 2.
A, A 32-year-old woman being evaluated for benign positional vertigo. The FLAIR scans have severe confluent periventricular disease and a few juxtacortical foci (arrows) of high signal. B, On postgadolinium scanning, numerous ring-enhancing demyelinating lesions are present, both periventricular-periatrial on the right and juxtacortical bilaterally.
Tables
Inclusion Criteria Exclusion Criteria CNS white matter lesions on MR imaging that are ovoid, well-circumscribed, >3 mm, and homogeneously hyperintense on T2-weighted images with or without involvement of the corpus callosum CNS lesions in a vascular pattern
Historical accounts of remitting clinical symptoms consistent with neurologic dysfunctionCNS lesions fulfill 3 of 4 Barkof criteria
1) One gadolinium-enhancing lesion or 9 T2-hyperintense lesions if no gadolinium-enhancing lesions
2) At least 1 infratentorial lesion
3) At least 1 juxtacortical lesion, and
4) At least 3 periventricular lesionsMR imaging anomalies can be explained by the direct physiologic effects of substances (recreational drug abuse, toxic exposure) or a medical condition
MR imaging phenotypes suggestive of leukoaraiosis (small-vessel ischemic disease) or extensive white matter pathology lacking involvement of the corpus callosumMR imaging anomalies do not account for clinically apparent impairment in social, occupational, or generalized areas of functioning White matter lesions are better accounted for by another medical condition Inclusion Criteria Exclusion Criteria ≥1 T2-hyperintense lesions on T2-weighted scans involving at least 2 of the following 4 locations: Periventricular white matter
Cortical/juxtacortical
Spinal cord
Infratentorial
Neurologic dysfunction suggestive of MS based on historical symptoms and/or objective signs
MR imaging abnormalities explained by other disease processes, especially considering age, vascular, toxins, or drug-related abnormalitiesEntity Distinguishing Clinical Features Distinguishing Imaging Features Important Keys to Diagnosis Toxins/drug-related Altered mental status changes during intoxication, history of substance abuse Deep gray matter frequently involved, symmetric lesions Urine and serum toxicology tests Age-related leukoaraiosis Older individual, cardiovascular risk factors Small (<3 mm), nonenhancing lesions in periventricular and deep white matter, coexistent striatocapsular lacunar disease, absence of callososeptal lesions/Dawson fingers–type lesions Lacunar disease and atypical white matter lesions for RIS in an older individual Migraines Headache or aura predominates Predominantly subcortical white matter lesions that are small (<3 mm) and do not enhance, few periventricular lesions Headache history and lack of typical imaging features consistent with RIS Vasculitis Episodic neurologic symptoms with superimposed strokes Gray and white matter lesions coexist, may have enhancing vessel wall and/or leptomeningeal enhancement, MRA with stenoses Systemic symptoms present, elevated erythrocyte sedimentation rate and/or C-reactive protein level, extra-/intracranial vessels abnormal, brain biopsy CADASIL Strokelike episodes, family history of similar clinical syndrome White matter disease favoring anterior temporal tip subcortical regions, external capsule, presence of lacunar infarcts Genetic testing diagnostic Collagen vascular diseases Clinical history of arthritis, long-standing chronic disease, episodic Gray and white matter lesions ± vasculitis, occasional encephalitis Clinical symptoms of a systemic disorder and presence of serologic autoantibodies/inflammatory markers ADEM Encephalitis, seizures, children > adults, history of viral/vaccine prodrome Gray matter disease predominates, more diffuse enhancement, may have positive findings on DWI History of prodromal virus infection or vaccination, encephalopathic Posttraumatic History of ≥1 traumatic, sports-related event Favors gray-white matter junction, hemorrhagic products present, classic tears in splenium-brain stem deep gray matter Hemorrhage and stereotypical locations of disease at shearing sites Note:—ADEM indicates acute disseminated encephalomyelitis.
