Case 9: A special type of perivascular space occurs in the anterior temporal lobe and can mimic a cystic tumor. This is also a form of leptomeningeal enhancement. Many neurological diseases can mimic MS both clinically and radiologically.
One of the most common questions in daily radiology practice when we see an image like the one on the left is: The edema will regress and finally only the center will remain as a hyperintense lesion on T2WI. Case 7 Case 7. Differentiating them from foci of encephalomalacia that result from chronic lacunar infarcts can be challenging but is important as imaging findings of ischemia can lead to patients being put on medication such as antiplatelet therapy.
Expanding Virchow Robin spaces in the midbrain causing hydrocephalus. Most incidentally found WMLs will have a vascular origin. These are discussed separately: DD multiple patchy lesions On the left a collection of images with multiple punctate and patchy lesions in the WM.
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 distribution of lesions is quite similar to MS.
First look at the image and look for lesions that are specific for MS. MR appearance.Virchow–Robin space - Video Learning - confort-durable.com
There is punctate enhancement in the basal nuclei. Fazekas II - in the deep white matter can be considered normal in aging. The McDonald criteria make use of the clinical presentation and the advances of MR imaging. By the way did you notice the lesion in the brainstem? Loading more images... Central Nervous System.
When we look at the prevalence of the white matter diseases, you will notice that there are enormous differences. The image on the left is an axial T2 weighted image illustrating typical vascular brainstem involvement, with a central involvement of the transverse pontine fibers. They are found in normotensive patients, but more common in hypertensives.
Or should we think of more uncommon diseases? Cases and figures Imaging differential diagnosis.
Rarely the size of the space is so large that produces mass effect on the adjacent brain parenchyma and it can cause hydrocephalus. On T2 sequences, a traversing vessel is sometimes seen. Appears in the midbrain mainly in the cerebral peduncles.