Article Text
Statistics from Altmetric.com
Introduction
Demyelinating disorders of the central nervous system may be divided into primary (cause unknown, eg, multiple sclerosis (MS)) and secondary (eg, infective, hypoxic–ischaemic, metabolic, toxic) processes. The underlying cause damages the myelin sheath and/or oligodendrocyte. MRI is the imaging modality of choice because of its high spatial and contrast resolution, but imaging features are often non-specific.
The most common causes of multifocal white matter lesions are perivascular spaces, ischaemia (small vessel disease) and MS.
Conclusion
Many disease processes can affect the white matter, and some may be difficult to differentiate clinically from MS. This review is intended to describe the classical and more unusual MR features of MS and how this disease may be distinguished from other processes that similarly involve the white matter.⇓⇓⇓⇓⇓⇓⇓⇓⇓⇓⇓⇓⇓⇓⇓⇓⇓⇓⇓⇓⇓⇓⇓⇓⇓⇓
- In this window
- In a new window
Imaging red flags—? MS- consider alternate diagnosis*
T2W axial MRI of a neurologically normal 45-year-old shows small ill-defined foci of high T2 signal in the frontal subcortical white matter. These are almost certainly age-related changes of no significance.
T2W axial (A) and axial apparent diffusion coefficient MRIs (B) in a 63-year-old man with sudden onset right hemiparesis, showing multiple small peripheral, poorly defined foci of high T2 signal in the frontal lobes and adjacent to the trigones of both lateral ventricles—more numerous than in the patient in figure 1. He is a smoker. The cause of his right hemiparesis is an ischaemic stroke in the deep white matter: the result of small vessel disease. This appears as an area of decreased diffusion on the apparent diffusion coefficient map (B).
Axial T2W MRIs in a 70-year-old man with diabetes mellitus and hypertension, showing diffuse high T2 signal in the deep white …
Footnotes
-
Competing interests None.
-
Provenance and peer review Commissioned; internally peer reviewed.
Linked Articles
- Editors' choice
Read the full text or download the PDF:
Other content recommended for you
- Imaging in multiple sclerosis and related disorders
- Imaging evaluation of demyelinating processes of the central nervous system
- Practical approach to the diagnosis of adult-onset leukodystrophies: an updated guide in the genomic era
- Immune-mediated conditions affecting the brain, eye and ear (BEE syndromes)
- A practical approach to diagnosing adult onset leukodystrophies
- How to diagnose difficult white matter disorders
- Diagnostic approach in adult-onset neurometabolic diseases
- Demyelinating disorder of the central nervous system occurring in black South Africans
- Regional variations in the extent and pattern of grey matter demyelination in multiple sclerosis: a comparison between the cerebral cortex, cerebellar cortex, deep grey matter nuclei and the spinal cord
- A case of oligodendroglioma and multiple sclerosis: Occam’s razor or Hickam’s dictum?