Limits...
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

(A and B) 18 year old male was admitted with progressive parapalegia of 3 months duration. Earlier in the year he had similar weakness which improved partially when he was admitted to a local hospital for fever and upper respiratory infection (review of old prescriptions revealed that he had received vitamin supplements). Clinically he was anemic and had hyper pigmentation of distal extremities (Fig. 5A). Peripheral smear and bone marrow confirmed the diagnosis of megaloblastic anemia. MRI of the spinal cord (Fig. 5B) showed on T2W images, linear hyperintense lesion in the cervical and upper dorsal cord sparing the anterior column. He improved moderately with Vitamin B12 therapy
© Copyright Policy - open-access
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC2811971&req=5

Figure 0005: (A and B) 18 year old male was admitted with progressive parapalegia of 3 months duration. Earlier in the year he had similar weakness which improved partially when he was admitted to a local hospital for fever and upper respiratory infection (review of old prescriptions revealed that he had received vitamin supplements). Clinically he was anemic and had hyper pigmentation of distal extremities (Fig. 5A). Peripheral smear and bone marrow confirmed the diagnosis of megaloblastic anemia. MRI of the spinal cord (Fig. 5B) showed on T2W images, linear hyperintense lesion in the cervical and upper dorsal cord sparing the anterior column. He improved moderately with Vitamin B12 therapy

Mentions: Vitamin B12 deficiency presents with progressive myelopathy which may sometimes appear to remit and relapse. Occasionally it presents as myeloneuropathy with cognitive dysfunction. In developing countries alcoholism, malnutrition and ileocecal tuberculosis are the common causes of Vitamin B12 deficiency. In a review of 63 case of sub acute combined degeneration seen in a period of 3 years, Aron et al,[57] reported that megaloblastic anemia was seen in all their patients. Striking skin changes especially hyper pigmentation of extremities and glossitis may be noted in nearly a third of patients [Figure 5A]. MRI demonstrates diffuse and multiple segment involvement of cervical cord in majority of the patients, although the pathology begins in the thoracic cord [Figure 5B]. Characteristic hyperintense signals on T2 W images associated with cord edema are seen predominantly involving the posterior column of the spinal cord.[58] Early recognition of this condition is essential, as it is reversible.


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

Pandit L - Ann Indian Acad Neurol (2009)

(A and B) 18 year old male was admitted with progressive parapalegia of 3 months duration. Earlier in the year he had similar weakness which improved partially when he was admitted to a local hospital for fever and upper respiratory infection (review of old prescriptions revealed that he had received vitamin supplements). Clinically he was anemic and had hyper pigmentation of distal extremities (Fig. 5A). Peripheral smear and bone marrow confirmed the diagnosis of megaloblastic anemia. MRI of the spinal cord (Fig. 5B) showed on T2W images, linear hyperintense lesion in the cervical and upper dorsal cord sparing the anterior column. He improved moderately with Vitamin B12 therapy
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 0005: (A and B) 18 year old male was admitted with progressive parapalegia of 3 months duration. Earlier in the year he had similar weakness which improved partially when he was admitted to a local hospital for fever and upper respiratory infection (review of old prescriptions revealed that he had received vitamin supplements). Clinically he was anemic and had hyper pigmentation of distal extremities (Fig. 5A). Peripheral smear and bone marrow confirmed the diagnosis of megaloblastic anemia. MRI of the spinal cord (Fig. 5B) showed on T2W images, linear hyperintense lesion in the cervical and upper dorsal cord sparing the anterior column. He improved moderately with Vitamin B12 therapy
Mentions: Vitamin B12 deficiency presents with progressive myelopathy which may sometimes appear to remit and relapse. Occasionally it presents as myeloneuropathy with cognitive dysfunction. In developing countries alcoholism, malnutrition and ileocecal tuberculosis are the common causes of Vitamin B12 deficiency. In a review of 63 case of sub acute combined degeneration seen in a period of 3 years, Aron et al,[57] reported that megaloblastic anemia was seen in all their patients. Striking skin changes especially hyper pigmentation of extremities and glossitis may be noted in nearly a third of patients [Figure 5A]. MRI demonstrates diffuse and multiple segment involvement of cervical cord in majority of the patients, although the pathology begins in the thoracic cord [Figure 5B]. Characteristic hyperintense signals on T2 W images associated with cord edema are seen predominantly involving the posterior column of the spinal cord.[58] Early recognition of this condition is essential, as it is reversible.

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