Neuro White Matter Disease

Front 1

Multiple sclerosis MR Spectroscopy

Back 1

Decreased: NAA

Increased: choline, lipids, lactate

Front 2

Tumefactive MS can give this nonspecific appearance

Back 2

ring like enhancement (incomplete ring)
*no significant mass effect

Front 3

NMO-IgG is an antibody specific for what demyelinating disease?

Back 3

Devic disease
-optic tracts
-spinal cord

Front 4

name 3 toxic white matter diseases

Back 4

osmotic demyelination-rapid Na correction, primarily pons

Marchiafava-bignami- corpus callosum in male alcholics
-thin hypointesnse middle layer on T1 of thinned corpus callosum

Wernicke encephalopathy- T2 prolongation and possible enhancement in mammillary bodies and medial thalamus.

Front 5

young person with recurrent infarcts, symmetric subcortical white matter increased T2 foci in the anterior temporal and paramedian frontal lobes

Back 5

CADASIL

Front 6

Infectious viral white matter disease ddx

Back 6

PML
SSPE

Front 7

Who does PML affect?

Back 7

mostly AIDS patients, immunocompromised

Front 8

Imaging of PML?

Back 8

asymmetric multifocal white matter lesions that become confluent
-arcuate (U fibers) involved

Front 9

Differentiate PML from HIV encephalitis? 3 features

Back 9

1. bilateral and symmetric in HIV
2. HIV spares subcortical white matter
3. HIV associated with cerebral atrophy

Front 10

Tysabri in MS may cause what?

Back 10

PML

Front 11

SSPE

Back 11

demyelination from reactivation of measles virus
periventricular white matter lesions

**has surrounding edema and mass effect.**
-distinct from other white matter lesions

Front 12

who gets ADEM?

Back 12

usually children after viral infection or immunization

Front 13

ADEM

Back 13

similar to MS
optic neuritis and spinal cord involvement

*Hurst variant is highly fulminant form

Front 14

Tuberculoma can appear similar to a pyogenic abscess, what may help differentiate it?

Back 14

centrally low T2 as opposed to high T2 in abscess

Front 15

Lyme disease causes T2 hyperintense lesions in the white matter where?

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frontal subcortical white matter
- may also have enhancement of cranial nerves or meningeal enhancement

Front 16

Most common imaging finding in CNS infection of AIDS patients with cryptococcus

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hydrocephalus

*gelatinous pseudocysts along basal ganglia
*ring enhancing cryptococcomas wtihin the ventricles

Front 17

Intraventricular neurocystercercosis usually occurs where?

Back 17

aqueduct and 4th ventricle

Front 18

What does the last stage of neurocysticercosis look like?

Back 18

small calcifications on CT and susceptibility on GRE

Front 19

Most common mass lesion in AIDS patients?

Back 19

Toxoplasmosis

Front 20

What is the asymmetric target sign?

Back 20

specific, not commonly seen sign that is specific for toxo.
-eccentric nodule of enhancement along the enhancing wall of the toxo lesion.
-hypometabolic on PET, negative on thallium

Front 21

HIV encephalopathy

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atrophy
symetric high T2, spares U fibers

Front 22

CMV encephalitis

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immunosuppressed
most commonly ventriculitis or meningoencephalitis
*subependymal FLAIR hyperintensity and enhancement throughout ventricular system

Front 23

What disease casues cortical ribboning? (diffuse ribbonlike FLAIR hyperintensity and restricted diffusion of the cerebral cortex?

Back 23

Creutzfeldt-Jakob disease

Front 24

Two other signs seen in CJD

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Pulvinar sign and hockey stick sign (thalamus) on FLAIR

Front 25

Classic appearance in the brain of liver disease

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hyperintense signal on T1-weighted images in the:
Globus pallidus
Substantia Nigra

Front 26

hypoxic ischemic encephalopathy

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circulatory or respiratory failure
CT: loss of Gray white differentiation, cerebral hypoattenuation, white cerebellum sign
Mr:FLAIR and DWI hyperintensity

Front 27

Poisoning with what can presents with optic neuritis?

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methanol

Front 28

Symmetric T2 prolongation and restricted diffuseion of the globus pallidus

Hint: poisoning

Back 28

Carbon monoxide