White Brain Disease Pictures

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Pons Lesions

Fig. 21.3. A boy with cerebral XALD. The first three rows show images at the age of 9 years. Note the frontal predominance of the lesions with involvement of the genu of the corpus callo-sum and the anterior limb of the internal capsule.The U fibers are relatively spared. Also note the involvement of the fronto pontine tracts at the level of the midbrain.The three zones are visible, although less clearly than in Fig. 21.1, with enhancement of the middle zone on the T1-weighted images. (Continue see next page)

Fig. 21.3. A boy with cerebral XALD. The first three rows show images at the age of 9 years. Note the frontal predominance of the lesions with involvement of the genu of the corpus callo-sum and the anterior limb of the internal capsule.The U fibers are relatively spared. Also note the involvement of the fronto pontine tracts at the level of the midbrain.The three zones are visible, although less clearly than in Fig. 21.1, with enhancement of the middle zone on the T1-weighted images. (Continue see next page)

treatment of XALD: dietary treatment and bone marrow transplantation. Dietary treatment should be applied in all asymptomatic patients in an attempt to delay and, hopefully, prevent the onset of clinical symptoms. Unfortunately, dietary treatment is not an absolute preventive. Bone marrow transplantation is indicated for patients in whom cerebral demyelina-tion is starting, especially young patients without AMN, but not for patients with a normal MRI or patients with entirely stable MRI abnormalities. Loes et al. (1994 and 2003) developed a 34-point scoring method for the grading of MRI abnormalities. It has

Normal Mri

Fig. 21.3. (continued). A boy with cerebral XALD. The second with spread over almost the entire brain.Only the parieto-oc-three rows show the follow-up MRI, obtained 1.5 years later. cipital region is partially spared. The cerebellar white matter The images demonstrate serious progression of the disease remains intact

Fig. 21.3. (continued). A boy with cerebral XALD. The second with spread over almost the entire brain.Only the parieto-oc-three rows show the follow-up MRI, obtained 1.5 years later. cipital region is partially spared. The cerebellar white matter The images demonstrate serious progression of the disease remains intact been found that the Loes score has predictive value. With a score higher than 3, almost all patients worsen, irrespective of age; only 10% remain neurologi-cally stable. With a score of 1-3,60% of patients worsen, irrespective of age, but survival is longer. If the Loes score is below 1, prognosis depends on the age of the patient: among patients aged between 3 and 7 years, 30 % will develop rapidly progressive cerebral demyelination; in the age group between 7 and 10 years, 10% will develop rapidly progressive cerebral demyelination; while in the age group above 10 years, rapidly progressive cerebral demyelination is rare and AMN is more likely. Contrast enhancement also has predictive value: absence of enhancement is associated with stable disease in 80-85% of the patients, whereas clear contrast enhancement is an indication

White Matter Disease The Brain

Fig. 21.4. A 45-year-old man with an AMN clinical phenotype. The T2-weighted images (upper two rows) show the involvement of the cerebellar white matter, the brain stem tracts, the splenium of the corpus callosum,and the posterior limb of the internal capsule. Some enhancement occurs after injection of contrast (third row)

Fig. 21.4. A 45-year-old man with an AMN clinical phenotype. The T2-weighted images (upper two rows) show the involvement of the cerebellar white matter, the brain stem tracts, the splenium of the corpus callosum,and the posterior limb of the internal capsule. Some enhancement occurs after injection of contrast (third row)

of active inflammatory demyelination and is associated with progression in 85-90 % of the patients. Diffusion tensor imaging may be more sensitive than conventional MRI and show abnormalities in areas that are not (yet) abnormal on conventional images. The potential role of magnetization contrast imaging in the monitoring of XALD patients is presently not clear. The decrease in magnetization transfer ratios reflects the three zones of white matter involvement, the lower ratios being present in the central burnt-out region. Normal-appearing white matter has a normal magnetization transfer ratio. The findings at MRS of the brain also have predictive value, in particular the findings just outside the visible lesion. If the N-acety-laspartate:choline ratio is decreased, this is evidence for impending demyelination in the area and disease

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Responses

  • benjamin
    Can normal mri have white areas?
    7 months ago

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