Neuroradiology : multiple patchy lesions

 On the 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.

ADEM
Key findings: Multifocal lesions in WM and basal ganglia 10-14 days following infection or vaccination.
As in MS, ADEM can involve the spinal cord, U-fibers and corpus callosum and sometimes show enhancement.
Different from MS is that the lesions are often large and in a younger age group. The disease is monophasic.

Lyme
2-3mm 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
Progressive Multifocal Leukoencephalopathy (PML) is a demyelinating disease caused by JC virus in immunosuppressed patients.
Key finding: space-occupying, nonenhancing WMLs in the U-fibers (unlike HIV or CMV).
PML may be unilateral, but more often it is bilateral and asymmetrical.
Click here for more information.

Virchow Robin spaces
Key finding: Bright on T2WI and dark on FLAIR.

Small vessel disease
WMLs in the deep white matter. Not located in corpus callosum, juxtaventricular or juxtacortical.
In many cases there are also

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