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Differential diagnosis of white matter diseases in the tropics: An overview.

Pandit L - Ann Indian Acad Neurol (2009)

Bottom Line: Diagnosing post infectious demyelinating disorders is equally challenging since more than a third of cases seen in the tropics do not present with history of past infection or vaccinations.Metabolic and deficiency disorders such as Wernicke's encephalopathy, osmotic demyelinating syndrome associated with extra pontine lesions and Vitamin B12 deficiency states can occassionaly cause confusion in diagnosis.This review considers a few important disorders which manifest with white matter changes on MRI and create diagnostic difficulties in a population in the tropics.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurology, KS Hegde Medical Academy, Mangalore-575018, Karnataka, India.

ABSTRACT
In hospitals in the tropics, the availability of magnetic resonance imaging (MRI) facilities in urban areas and especially in teaching institutions have resulted in white matter diseases being frequently reported in a variety of clinical settings. Unlike the west where multiple sclerosis (MS) is the commonest white matter disease encountered, in the tropics, there are myriad causes for the same. Infectious and post infectious disorders probably account for the vast majority of these diseases. Human immunodeficiency virus (HIV) infection tops the list of infective conditions. Central nervous system (CNS) tuberculosis occasionally presents with patchy parenchymal lesions unaccompanied by meningeal involvement. Human T cell leukemia virus (HTLV) infection and cystic inflammatory lesions such as neurocysticercosis are important causes to be considered in the differential diagnosis. Diagnosing post infectious demyelinating disorders is equally challenging since more than a third of cases seen in the tropics do not present with history of past infection or vaccinations. Metabolic and deficiency disorders such as Wernicke's encephalopathy, osmotic demyelinating syndrome associated with extra pontine lesions and Vitamin B12 deficiency states can occassionaly cause confusion in diagnosis. This review considers a few important disorders which manifest with white matter changes on MRI and create diagnostic difficulties in a population in the tropics.

No MeSH data available.


Related in: MedlinePlus

26 year male presented with acute onset paraparesis, retention of urine, and disorientation. One month earlier he had right focal motor seizures with transient post ictal weakness for which he had been investigated elsewhere with no details. MRI brain [Figure 1A] on T2W images showed large hyperintense lesions in the temporal and parietal subcortex on the right side with scattered small hyperintense lesions predominantly in subcortical white matter of the opposite hemisphere. MRI of the spinal cord [Figure 1B] on T2W images showed liner hyperintense lesion in the dorsal cord which enhanced moderately following intravenous contrast. He was HIV positive and succumbed shortly thereafter.Autopsy of the brain lesion confirmed the clinical diagnosis of progressive multifocal leucoencephalopathy
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Figure 0001: 26 year male presented with acute onset paraparesis, retention of urine, and disorientation. One month earlier he had right focal motor seizures with transient post ictal weakness for which he had been investigated elsewhere with no details. MRI brain [Figure 1A] on T2W images showed large hyperintense lesions in the temporal and parietal subcortex on the right side with scattered small hyperintense lesions predominantly in subcortical white matter of the opposite hemisphere. MRI of the spinal cord [Figure 1B] on T2W images showed liner hyperintense lesion in the dorsal cord which enhanced moderately following intravenous contrast. He was HIV positive and succumbed shortly thereafter.Autopsy of the brain lesion confirmed the clinical diagnosis of progressive multifocal leucoencephalopathy

Mentions: Patients may present for the first time with neurological deficits which necessitate imaging and then be found in the course of further work up to be HIV positive [Figure 1A and B]. HIV related CNS disorders are varied and may be due to the direct effect of the virus or a consequence of opportunistic infections, neoplasms and vascular diseases. Clinical findings are often nonspecific and subtle ranging from focal abnormalities and mild cognitive impairment to gross deficits and altered sensorium. Radiological features overlap the various disease subtypes. The abnormalities may be either diffuse or patchy.


Differential diagnosis of white matter diseases in the tropics: An overview.

Pandit L - Ann Indian Acad Neurol (2009)

26 year male presented with acute onset paraparesis, retention of urine, and disorientation. One month earlier he had right focal motor seizures with transient post ictal weakness for which he had been investigated elsewhere with no details. MRI brain [Figure 1A] on T2W images showed large hyperintense lesions in the temporal and parietal subcortex on the right side with scattered small hyperintense lesions predominantly in subcortical white matter of the opposite hemisphere. MRI of the spinal cord [Figure 1B] on T2W images showed liner hyperintense lesion in the dorsal cord which enhanced moderately following intravenous contrast. He was HIV positive and succumbed shortly thereafter.Autopsy of the brain lesion confirmed the clinical diagnosis of progressive multifocal leucoencephalopathy
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2811971&req=5

Figure 0001: 26 year male presented with acute onset paraparesis, retention of urine, and disorientation. One month earlier he had right focal motor seizures with transient post ictal weakness for which he had been investigated elsewhere with no details. MRI brain [Figure 1A] on T2W images showed large hyperintense lesions in the temporal and parietal subcortex on the right side with scattered small hyperintense lesions predominantly in subcortical white matter of the opposite hemisphere. MRI of the spinal cord [Figure 1B] on T2W images showed liner hyperintense lesion in the dorsal cord which enhanced moderately following intravenous contrast. He was HIV positive and succumbed shortly thereafter.Autopsy of the brain lesion confirmed the clinical diagnosis of progressive multifocal leucoencephalopathy
Mentions: Patients may present for the first time with neurological deficits which necessitate imaging and then be found in the course of further work up to be HIV positive [Figure 1A and B]. HIV related CNS disorders are varied and may be due to the direct effect of the virus or a consequence of opportunistic infections, neoplasms and vascular diseases. Clinical findings are often nonspecific and subtle ranging from focal abnormalities and mild cognitive impairment to gross deficits and altered sensorium. Radiological features overlap the various disease subtypes. The abnormalities may be either diffuse or patchy.

Bottom Line: Diagnosing post infectious demyelinating disorders is equally challenging since more than a third of cases seen in the tropics do not present with history of past infection or vaccinations.Metabolic and deficiency disorders such as Wernicke's encephalopathy, osmotic demyelinating syndrome associated with extra pontine lesions and Vitamin B12 deficiency states can occassionaly cause confusion in diagnosis.This review considers a few important disorders which manifest with white matter changes on MRI and create diagnostic difficulties in a population in the tropics.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurology, KS Hegde Medical Academy, Mangalore-575018, Karnataka, India.

ABSTRACT
In hospitals in the tropics, the availability of magnetic resonance imaging (MRI) facilities in urban areas and especially in teaching institutions have resulted in white matter diseases being frequently reported in a variety of clinical settings. Unlike the west where multiple sclerosis (MS) is the commonest white matter disease encountered, in the tropics, there are myriad causes for the same. Infectious and post infectious disorders probably account for the vast majority of these diseases. Human immunodeficiency virus (HIV) infection tops the list of infective conditions. Central nervous system (CNS) tuberculosis occasionally presents with patchy parenchymal lesions unaccompanied by meningeal involvement. Human T cell leukemia virus (HTLV) infection and cystic inflammatory lesions such as neurocysticercosis are important causes to be considered in the differential diagnosis. Diagnosing post infectious demyelinating disorders is equally challenging since more than a third of cases seen in the tropics do not present with history of past infection or vaccinations. Metabolic and deficiency disorders such as Wernicke's encephalopathy, osmotic demyelinating syndrome associated with extra pontine lesions and Vitamin B12 deficiency states can occassionaly cause confusion in diagnosis. This review considers a few important disorders which manifest with white matter changes on MRI and create diagnostic difficulties in a population in the tropics.

No MeSH data available.


Related in: MedlinePlus