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Diferential Diagnosis o
White Matter LesionsMultiocal Disease
• Multiple sclerosis
• White matter ischemia
• Virchow-Robin Spaces
• Migraine
• Progressive Multifocal Leukoencephalopathy (PML
• !cute "isseminate" encephalomyelitis (!#$M
• Cerebral arteritis/vasculitis
• Periventricular leukomalacia
• Difuse axonal injury
• Central pontine myelinolysis
Difuse Disease
• White matter ischemia
• !" encephalitis
• #a$iation injury• Chemotherapy% methotrexate&
cisplatin& cytosine arabinosi$e& carmustine& an$
thiotepa
• ere$itary metabolic $isor$ers
Contiguous Periventricular Pattern
• White matter ischemia
• Cytomegalovirus ventriculitis
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Multiple 'clerosis
• (val or ovoi$
• Periventrical
• Corpus callosum re)uently involve$
• Perpen$icular to the ventricular surace *Da+son,s -ngers.
• 'ubcoritcal 0-bers& temporal lobes& brainstem&
cerebelluman$ spinal cor$
• (ptic nerve involvement
• ypointense on 12
•
3ocally enhance$ on 4o$olinium
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'agittal 15
6xial 126xial 15
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"ircho+0#obin 'paces
• C'3 spaces surroun$ing penetrating leptomeningealvessels
• #oun$& usual less than 205mm
• 7xtremely large "# spaces *82 cm. seen in basal
ganglia region• 6roun$ atria& near the anterior commissure
an$ in the
brainstem
• %ypointense on 3L6!#
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6xial 15 6xial3L6!#
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White Matter !schemia
• Most common cause o WML on M#!
• Periventricular caps& subcortical +hite matter&
opticra$iations& basal ganglia an$ brain stem
• 'pares the corpus callosum
• M#! spinal cor$ usually normal
• Mil"ly hypointense on 12
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6xial3L6!#
Coronal 12
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Migraine
• Multiple& small& punctate lesions
• Commonly involves anterior temporal lobe&
basalganglia& pons
• #esemble $eep +hite matter ischemia& also
mil"lyhypointense on 12
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6xial 15 6xial3L6!#
6xial 12
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Progressive Multiocal
Leukoencephalopathy *PML.
• Patchy& asymmetrical $istribution
• #oun$ or oval& homogenous +ith +ell $e-ne$ margins
• Classically involves rontal an$ parieto0occipital lobes
• Less commonly afects corpus callosum
• 9ot enhance$ by 4a$olinium
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6xial 15 6xial3L6!#
6xial4a$olinium 12
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6cute Disseminate$7ncephalomyelitis *6D7M.
• Patchy& asymmetrical $istribution
• Commonly involves brainstem& cerebrum&cerebellum&
an$ spinal cor$
•
!ncomplete& spotty enhancement on 4a$olinium
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6xial3L6!#
6xial3L6!#
6xial4a$olinium 12
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:ack to Mr; 4
• Lumbar puncture preorme$ on 5
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MacDonal$,s Criteria *5
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#eerences
• esselink B#; Diferential $iagnostic approach to M# imaging o
+hitematter $iseases; 1op Magn #eson !maging; 5A0A;
• Polman C& #eingol$ 'C& :an+ell :& et al;
Diagnostic criteria or multiplesclerosis% 5
