5. Neuro-Degenerative

Question 1

Multiple Sclerosis pattern

Answer 1

MS is the poster child of the “Perivascular pattern”

Favors involvement of the 1. juxtacotical and 2. periventricular regions

OVOID and FUSIFORM morphology

Juxtacorticval and periventricular plaques = FLAIR<T2>FLAIR</T2>

Question 2

McDonald Diagnostic Criteria for MS

Answer 2

Lesions Disseminated in SPACE
- Periventricular
- Juxtacortical
- infratentorial
- spinal cord

Lesions dissemiation in time:
Enhancing T2 bright lesion + T2 bright non-enhancing (in-active = lesions in different phases, therefore separated by time

SEPARATED by TIME and SPACE

Question 3

Answer 3

Multiple Sclerosis

T2/FLARI oval and periventricular lesions

Question 4

What differentiates MS from ADEM?

Answer 4

MS: Callo-septal interface involvement (98%)

Question 5

Active vs Not Active :

Answer 5

Acute demyelinating plaques = enhance + fluid restriction

Question 6

Tumor VS MS

Answer 6

MS = incomplete ring enhancement

Question 7

Answer 7

ADEM (Acute Disseminated Encephalomyelitis)

LARGE T2 bright lesions with ehancement in a nodular or open ring pattern

Lesions do NOT involve the
calloso-septal interface

Childhood-adolescents + POST viral/vaccination

Question 8

Answer 8

Acute Hemorrhagic Leukoencephalitis
Hurst Disease

Fulminant form of ADEM= massive brain swelling = death

Hemorrhagic part = autopsy

Question 9

Transverse Myelitis + Optic Neuritis.
Lesions in the Cord and the Optic Nerve

Answer 9

Devics (neuromyelitis Optica)

Question 10

Childhood variant of MS = fulminant and terrible = rapid death = febrile prodrome

Answer 10

MARGBURG!!! = DEATH

Question 11

a multi-infarct dementia that ONLY involves the white matter

It favors the white matter of the centrum
semiovale (white matter superior to the
lateral ventricles / corpus callosum).

Spares U fibers

Hypertension

OLD people 55-up

Answer 11

Subcortical Arteriosclerotic Encephalopathy

Question 12

55 y.o.

Answer 12

Subcortical Arteriosclerotic Encephalopathy

Question 13

40 y.o. + Migrain headache + strokes + dementia =

Answer 13

CADASIL (Cerebral Autosomal Dominant Arteriopathy with Subcortical Infarcts & Leukoencephalopathy

Severe white matter disease (hight
T2/FLAIR) involving mulitple vascular territories in the frontal and temporal lobe

CLASSIC: Temporal lobe involvement

IF 50+ = think of ADEM

Question 14

Most common cause of dementia

Answer 14

Alzheimer Disease

Question 15

2nd most common cause of dementia

Answer 15

Multi-infarct dimentia

Question 16

3rd most common cause of dementia

Answer 16

Dementia with Lewy bodies

Question 17

Tauopathy, Amyloid Cascade,
and Neurofibrillary Tangles =

Answer 17

Alzheimers

Question 18

Vascular dementia

Answer 18

Multi-infarct dementia

Question 19

Alpha synuclein and synucleinopathy

Answer 19

Dementia with Lewy bodies

Question 20

Most Classic Feature(s):
hippocampal atrophy (which
is first and out of proportion to
the rest of the brain atrophy).
They could ask temporal horn
atrophy > 3 mm , which is seen
in more than 65% of cases

Answer 20

Alzheimers

Question 21

Most Classic Feature(s):
Cortical infarcts and lacunar
infarcts are seen on MRI. Brain
atrophy (generalized) is usually
advanced for the patients age

Answer 21

Multi-infarct dementia

Question 22

Most Classic Feature(s):
Mild generalized atrophy
without lobar predominance
(unlike multi-infarct).
Hippocampi will be normal in
size (unlike AD)

Answer 22

Dementia with Lewy bodies