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26 Cards in this Set

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Genetic & Environmental
 
Identical Twins
Nonaffected Twin Has 30% Chance MS

Genetic & Environmental



Identical Twins


Nonaffected Twin Has 30% Chance MS

Undersurface CC-
Then Extends to Upper Aspect CC

Undersurface CC-


Then Extends to Upper Aspect CC

Posterior Fossa-Flair May Be Not Best Best

Posterior Fossa-Flair May Be Not Best Best

T1 later disease
Axonal Destruction
Volume of T1 Lesions Correlate With Degree of Disability

T1 later disease


Axonal Destruction


Volume of T1 Lesions Correlate With Degree of Disability

Perivenular Distribution
SWI

Perivenular Distribution


SWI

Cortical Lesions More Common Than Previously Known!

Cortical Lesions More Common Than Previously Known!

DIR Double Inversion Recovery
PD
T1 Inversion Recovery
BEST to See Cortical Lesions!

DIR Double Inversion Recovery


PD


T1 Inversion Recovery


BEST to See Cortical Lesions!

Lesion Medial Longitudinal Fasciculus
Internuclear Ophthaloplegia
Unable to ADDUCT Right Eye

Lesion Medial Longitudinal Fasciculus


Internuclear Ophthaloplegia


Unable to ADDUCT Right Eye

PosteroLateral Medulla MS
Better Seen on T2 Than Flair

PosteroLateral Medulla MS


Better Seen on T2 Than Flair

Periaqueductal Lesion Seen Better T1 IR Than on T2 Wt'd

Periaqueductal Lesion Seen Better T1 IR Than on T2 Wt'd

Regular T2 Wt'd Window Not See Lesion
Change Window- Lesion Right Root Entry Zone Better Seen!

Regular T2 Wt'd Window Not See Lesion


Change Window- Lesion Right Root Entry Zone Better Seen!

McDonald Criteria 2010
DIS
Dissemination in Space

McDonald Criteria 2010


DIS


Dissemination in Space

McDonald Criteria 2010
DIT
Dissemination in Time

McDonald Criteria 2010


DIT


Dissemination in Time

Myelin Breakdown Products-- Some Lesions Bright on Precontrast T1
Do Not Call Enhancement!

Myelin Breakdown Products-- Some Lesions Bright on Precontrast T1


Do Not Call Enhancement!

How Long Lesions Enhance? Depends on Size- 1 week to 100 weeks-  Larger lesions enhance longer

How Long Lesions Enhance? Depends on Size- 1 week to 100 weeks- Larger lesions enhance longer

Longer You Wait After Injection, Brighter is Contrast Enhancement Seen!
3, 6, 9, 12 minutes

Longer You Wait After Injection, Brighter is Contrast Enhancement Seen!


3, 6, 9, 12 minutes

Acute Plaques May Show Restricted Diffusion! But Not as much as infarction.

Acute Plaques May Show Restricted Diffusion! But Not as much as infarction.

Tumefactive MS
No Enhancement
Restricted Diffusion in Rim!

Tumefactive MS


No Enhancement


Restricted Diffusion in Rim!

Incomplete Ring of Enhancement
Spares Portion of Wall of Plaque

Incomplete Ring of Enhancement


Spares Portion of Wall of Plaque

Multifocal Demyelination (Marburg Variant)

Multifocal Demyelination (Marburg Variant)

Restricted Diffusion Periphery of lesion
-not abscess
-not embolic

Restricted Diffusion Periphery of lesion


-not abscess


-not embolic

Balo's Concentric Sclerosis
Onion Skin Appearance

Balo's Concentric Sclerosis


Onion Skin Appearance

Mag Transfer
Maximize Difference Between Normal Brain and Plaques

Mag Transfer


Maximize Difference Between Normal Brain and Plaques

Volumetric 3D Flair Cube
Obl Sag
Obl Axial 
Along Optic Nerve
Lesion Orbit Apex

Volumetric 3D Flair Cube


Obl Sag


Obl Axial


Along Optic Nerve


Lesion Orbit Apex

Optic Neuritis
Top Acute
Bottom Resolved

Optic Neuritis


Top Acute


Bottom Resolved

Optic Neuritis ?Risk of MS
0 Brain Lesions=25% Risk of MS
1-2 Brain Lesions=65%
>3 Brain Lesions=78%

Optic Neuritis ?Risk of MS


0 Brain Lesions=25% Risk of MS


1-2 Brain Lesions=65%


>3 Brain Lesions=78%

MS Cord
2D MERGE
Look at T2 Also
Axial and Sagittal

MS Cord


2D MERGE


Look at T2 Also


Axial and Sagittal

Devic Syndrome NMO
Benefits Aggressive Steroid/Plasmapheresis
76% Sensitive

Devic Syndrome NMO


Benefits Aggressive Steroid/Plasmapheresis


76% Sensitive

Devic
Long Segment Cord

Devic


Long Segment Cord

Overlap Imaging ADEM and MS

Overlap Imaging ADEM and MS

ADEM
"Monophasic" But May Be Long Phase--May See new lesions one to six months

ADEM


"Monophasic" But May Be Long Phase--May See new lesions one to six months

With Triple Therapy
Longer Survival

With Triple Therapy


Longer Survival

But With IRIS, Enhancement Much More Common

But With IRIS, Enhancement Much More Common

PML- Demyelinating Disease
Peripheral Restricted Diffusion (Demyelinating Sign)

PML- Demyelinating Disease


Peripheral Restricted Diffusion (Demyelinating Sign)

IRIS
Lot Edema and Stippled Enhancement
 
IRIS Also Seen With Cryptococcal Infection

IRIS


Lot Edema and Stippled Enhancement



IRIS Also Seen With Cryptococcal Infection

LYME Can do anything MS can do, including optic neuritis
MUST Alsway do Lyme Titers in suspected MS if clinical history of MS in question!

LYME Can do anything MS can do, including optic neuritis


MUST Alsway do Lyme Titers in suspected MS if clinical history of MS in question!

MS Should Not Enhance Cranial Nerves


Lyme Does #1 CNVII

SUSAC
RetinocochleacerebralMicroangiopathy
 
Misdx as MS

SUSAC


RetinocochleacerebralMicroangiopathy



Misdx as MS

SUSAC Misdx as MS
neg, lesion, then resolved
Not Enhance

SUSAC Misdx as MS


neg, lesion, then resolved


Not Enhance

Susac
Affect CC
But Spares the Undersurface of CC 
-Vasculits Not Demyelinating  Disease

Susac


Affect CC


But Spares the Undersurface of CC


-Vasculits Not Demyelinating Disease

If See Infarcts and Hemorrhage---
Think Vasculitis!!!!

If See Infarcts and Hemorrhage---


Think Vasculitis!!!!

Vasculits
Patchy- But Nonspecific

Vasculits


Patchy- But Nonspecific

Wegener's Disease
Fulminant
Whtie matter
Enhancement
Nasal Septum Involvement

Wegener's Disease


Fulminant


Whtie matter


Enhancement


Nasal Septum Involvement

Wegener's Disease
Enhancement Follows Vessels
MS Rounded Enhancement

Wegener's Disease


Enhancement Follows Vessels


MS Rounded Enhancement

Trident Shape in Pons
May or May Not Spare Corticospinal Tracts
 
Watershed Areas

Trident Shape in Pons


May or May Not Spare Corticospinal Tracts



Watershed Areas

Sem Neurol. 2011
Numerous Etiology for PRES- may be easier to list things not associated with PRES

Sem Neurol. 2011


Numerous Etiology for PRES- may be easier to list things not associated with PRES

Sarcoid-
Parenchymal Signal Hyperintensity
Also Enhancement along Vessels and Stippled

Sarcoid-


Parenchymal Signal Hyperintensity


Also Enhancement along Vessels and Stippled

Sarcoid
May Confuse This Case With MS

Sarcoid


May Confuse This Case With MS