Differential diagnosis of restricted diffusion confined to the cerebral cortex

Sheerin, Fintan; Pretorius, Pieter; Briley, Dennis; Meagher, Tom

doi:10.1016/j.crad.2007.12.018

Cited by 47 publications

(36 citation statements)

References 23 publications

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“…The gray matter of the cortex is particularly sensitive to changes in energy balance with its large energy demand (19) and the majority of the infarct-like lesions in MELAS preferentially involve the gray matter, with or without white matter extension as a function of the severity and acuity of the injury. Such a temporal progression can be seen both on the serial conventional MR images and DWI, and is evidenced by a shift in the declining ADC to the white matter, while the fully swollen cortical grey matter shows normal or increased ADC on short-term follow-up images (Fig.…”

Section: Discussionmentioning

confidence: 99%

“…These studies even suggested an increased ADC as a differential point from the cytotoxic edema of an ischemic origin. On the other hand, other studies (14-19) have described that ADC declines during an acute episode, suggesting the presence of cytotoxic edema even though the proposed pathophysiology was different from that of an ischemic stroke.…”

Section: Introductionmentioning

confidence: 91%

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Diffusion and Perfusion Characteristics of MELAS (Mitochondrial Myopathy, Encephalopathy, Lactic Acidosis, and Stroke-Like Episode) in Thirteen Patients

et al. 2011

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ObjectiveWe analyzed the diffusion and perfusion characteristics of acute MELAS (mitochondrial myopathy, encephalopathy, lactic acidosis, and stroke-like episode) lesions in a large series to investigate the controversial changes of the apparent diffusion coefficient (ADC) that were reported in prior studies.Materials and MethodsWe analyzed 44 newly appearing lesions during 28 stroke-like episodes in 13 patients with MELAS. We performed a visual assessment of the MR images including the ADC and perfusion maps, comparison of the ADC between the normal and abnormal areas, comparison of % ADC between the 44 MELAS lesions and the 30 acute ischemic infarcts. In addition, the patterns of evolution on follow-up MR images were analyzed.ResultsDecreased, increased, and normal ADCs were noted in 16 (36%), 16 (36%), and 12 (27%) lesions, respectively. The mean % ADC was 102 ± 40.9% in the MELAS and 64 ± 17.8% in the acute vascular infarcts (p < 0.001), while perfusion imaging demonstrated hyper-perfusion in six acute MELAS lesions. On follow-up images, resolution, progression, and tissue loss were noted in 10, 4, and 17 lesions, respectively.ConclusionThe cytotoxic edema gradually evolves following an acute stroke-like episode in patients with MELAS, and this may overlap with hyper-perfusion and vasogenic edema. The edematous swelling may be reversible or it may evolve to encephalomalacia, suggesting irreversible damage.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 91%

Diffusion and Perfusion Characteristics of MELAS (Mitochondrial Myopathy, Encephalopathy, Lactic Acidosis, and Stroke-Like Episode) in Thirteen Patients

et al. 2011

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“…Diffusion restriction on diffusionweighted imaging is considered a hallmark of ischemia, but is not pathologically specific. 33 It could be argued that stroke was not proven in our patient, and conventional angiogram might have provided more definitive evidence of vascular dissection.…”

Section: Discussionmentioning

confidence: 93%

Masquerades of Acquired Demyelination in Children

O’Mahony

Bar‐Or²,

Arnold

et al. 2012

J Child Neurol

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The diagnosis of acquired demyelinating syndromes of the central nervous system in children requires exclusion of other acute central nervous system disorders. In a 23-site national demyelinating disease study, standardized clinical, laboratory, and magnetic resonance imaging (MRI) data were obtained prospectively from onset, and serially at 3, 6, and 12 months and annually. Twenty of 332 (6%) participants (mean [SD] age, 10.21 [4.32] years; 12 (60%) female) were ultimately diagnosed with vascular disorders (primary or secondary central nervous system vasculitis, vasculopathy, stroke, or migraine, n = 11 children), central nervous system malignancy (n = 3), mitochondrial disease (n = 2), or central nervous system symptoms in the accompaniment of confirmed infection (n = 4). Red flags that may serve to distinguish disorders in the differential of acquired demyelination are described.

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“…The deep grey matter such as the thalamus may also be affected probably reflecting its high metabolic demand. On MRI the cortical lesions preferentially affect the cortical ribbon with relative sparing of the deeper white matter9 (figure 3), again reflecting the higher metabolic demand of these regions. Early reports argued that MELAS patients showed normal or increased apparent diffusion coefficient (ADC) on MRI;10 however, this has proven controversial and the consensus is probably now that there is restricted diffusion and so reduced ADC, as in ischaemic stroke 11.…”

Section: Radiological Featuresmentioning

confidence: 98%

Mitochondrial myopathy, encephalopathy, lactic acidosis and stroke-like episodes: an important cause of stroke in young people

Goodfellow

Dani

Stewart

et al. 2012

Postgraduate Medical Journal

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Mitochondrial myopathy, encephalopathy, lactic acidosis and stroke-like episodes is a progressive, multisystem mitochondrial disease affecting children and young adults. Patients acquire disability through stroke-like episodes and have an increased mortality. Eighty per cent of cases have the mitochondrial mutation m.3243A>G which is linked to respiratory transport chain dysfunction and oxidative stress in energy demanding organs, particularly muscle and brain. It typically presents with seizures, headaches and acute neurological deficits mimicking stroke. It is an important differential in patients presenting with stroke, seizures, or suspected central nervous system infection or vasculitis. Investigations should exclude other aetiologies and include neuroimaging and cerebrospinal fluid analysis. Mutation analysis can be performed on urine samples. There is no high quality evidence to support the use of any of the agents reported in small studies. This article summarises the core clinical, biochemical, radiological and genetic features and discusses the evidence for a number of potential therapies.

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Differential diagnosis of restricted diffusion confined to the cerebral cortex

Cited by 47 publications

References 23 publications

Diffusion and Perfusion Characteristics of MELAS (Mitochondrial Myopathy, Encephalopathy, Lactic Acidosis, and Stroke-Like Episode) in Thirteen Patients

Diffusion and Perfusion Characteristics of MELAS (Mitochondrial Myopathy, Encephalopathy, Lactic Acidosis, and Stroke-Like Episode) in Thirteen Patients

Masquerades of Acquired Demyelination in Children

Mitochondrial myopathy, encephalopathy, lactic acidosis and stroke-like episodes: an important cause of stroke in young people

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