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Editorial Reviews. Review. Allow[s] a quick visual review of common diagnoses in a volume that easily fits into one's lab coatAmerican Journal of.
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  • Paolo Maniglio Enzo Ricciardi Latest Mendeley Data Datasets. Mendeley Data Repository is free-to-use and open access. It enables you to deposit any research data including raw and processed data, video, code, software, algorithms, protocols, and methods associated with your research manuscript. Use the coronal scout to plan the true midsagittal image parallel to the falx and other midline structures.

    On a true midsagittal image a line is drawn through the pituitary gland and the roof of the fourth ventricle fastigium. This is called the HYFA: hypophysis-fastigium line. Subsequently the slices are positioned with the middle slice at the lower border of the splenium of the corpus callosum. Gadolinium is not necessary when only the spinal cord is examined. Contrary to the brain there will only rarely be enhancement in the cord. Only when other diagnoses are considered e. When we look at the prevalence of the white matter diseases, you will notice that there are enormous differences.

    Hereditary diseases are extremely uncommon as individual diseases, but as a group they are not that uncommon, but still far more uncommon than MS. If we look at the prevalence of Lyme disease, which is a rather popular disease at the moment, then we will notice that it still is a very uncommon disease despite of all the serological tests that are being performed nowadays. They are more common in older people and in patients with vascular risk factors like atherosclerosis, high blood pressure, high cholesterol, diabetes, amyloid angiopathy, hyperhomocysteinemia, atrial fibrillation etc.

    If a patient is clinically suspected of having MS and the MR-images support that diagnosis, than you should not consider the possibility of Lyme's disease and neuro-SLE in the differential diagnosis, because they have such a low prevalence. There must be other ways to impress your colleagues. These diagnoses are only worth mentioning if there are clinical findings that support these diagnoses. Consequently, it is not wise to put MS in the differential diagnosis if the clinician does not suspect the patient of having MS and on the MR incidental WMLs are found.

    On the other hand if a patient is clinically suspected of having MS and multiple WMLs are found, our major concern is the differential diagnosis MS versus vascular disease and we have to follow the McDonald criteria. The differential diagnosis of white matter lesions is extremely long.

    The most common inflammatory disease is Multiple Sclerosis. Inherited diseases usually will have symmetrical abnormalities, so they have to be differentiated from intoxications. On the left a collection of images with multiple punctate and patchy lesions in the WM. Some will be discussed in more detail. There is no complete overlap between the images on the left and the text on the right. Borderzone infarction Key finding : typically these lesions are located in only one hemisphere, either in deep watershed area or peripheral watershed area. In the case on the left the infarction is in the deep watershed area.

    Different from MS is that the lesions are often large and in a younger age group. The disease is monophasic. Lyme mm lesions simulating MS in a patient with skin rash and influenza-like illness. Other findings are high signal in spinal cord and enhancement of CN7 root entry zone. Sarcoid Sarcoid is the great mimicker. The distribution of lesions is quite similar to MS. PML may be unilateral, but more often it is bilateral and asymmetrical. Click here for more information.

    Small vessel disease WMLs in the deep white matter. Not located in corpus callosum, juxtaventricular or juxtacortical. In many cases there are also. On the left a collection of images with multiple enhancing lesions in the WM. Vasculitis Most diseases with vasculitis are characterized by punctiform enhancement. Behcet Behcet is more commonly seen in Turkish patients.

    Typical findings are brainstem lesions with nodular enhancement in the acute phase.

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    Borderzone infarction Peripheral border zone infarctions may enhance in the early phase. On the T2W image there are multiple high intensity lesions in the basal ganglia. This signal intensity in combination with the location is typical for VR spaces. Virchow Robin spaces are CSF spaces around penetrating leptomeningeal vessels. They are typically located in basal ganglia, around atria, near the anterior commissure and in the middle of the brainstem.

    Usually they are small except around the anterior commissure, where perivascular spaces can be larger. On this image we see both very wide VR spaces as well as confluent hyperintense lesions in the WM. This is an extreme case and this condition is known as etat crible. VR spaces enlarge with age and hypertension as a result of atrophy of surrounding structures.

    Periventricular caps are hyperintense regions around the anterior and posterior pole of the lateral ventricles and are associated with myelin pallor and dilated perivascular spaces. Periventricular bands or 'rims' are thin linear lesions along the body of the lateral ventricles and are associated with subependymal gliosis. Normal Aging 2 The clinical significance of white matter changes in aging has not been fully elucidated. There is a relationship between several cerebrovascular risk factors and the presence of white matter changes.

    One of the strongest risk factors however, apart from hypertension, is that of age.

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    The location of these white matter lesions is in the deep white matter and it is important to notice that these lesions are not juxtaventricular, not juxtacortical and not located in the corpus callosum. Unlike in MS, they do not touch the ventricles or the cortex. Given the a priori greater chance of hypoxic-ischemic WM lesions, we must conclude that these WMLs probably have a vascular origin. Only if the clinical findings strongly direct us towards inflammatory, infectious, toxic or other diseases, should we consider these diagnoses. Suggesting the diagnosis of MS in a patient with these MR findings and with no clinical suspicion for MS would be unwise.

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    The spinal cord in this patient was normal. If the differentiation between a vascular origin of WMLs and MS is difficult for instance in an older patient who is suspected of MS, than an MR of the spinal cord can be helpful 2. Vascular disease 2 When we go back to the first case that was shown, it is now very obvious that this is vascular disease. There is widespread disease in the deep white matter, but the U-fibers and corpus callosum are not involved. Ischemic WMLs present as lacunar infarcts, watershed infarcts or diffuse hyperintense lesions within the deep white matter.

    Lacunar infarcts are due to arteriolar sclerosis of small penetrating medullary arteries. Watershed infarctions are the result of atherosclerosis of larger vessels, for instance carotid obstruction or the result of hypoperfusion. They are found in normotensive patients, but more common in hypertensives. Besides lesions in the deep WM, there are some juxtaiventricular lesions and even Dawson finger-like lesions.

    The final diagnosis was sarcoid.

    Article - Infections of the spine: A review of clinical and imaging findings

    Sarcoid has surpassed neurosyphilis as the great mimicker. Sarcoid 2 On the left we see the coronal Gd-enhanced T1W images of this patient. First study these images, than continue. There is punctate enhancement in the basal nuclei. This is seen in sarcoid and can also be seen in SLE or other vasculitis. Typical for sarcoid in this case is the leptomeningeal enhancement yellow arrow.