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1. ADEM in 4 different children

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Figure 17-1

ADEM in 4 different children.

A. A FLAIR image of a 2-year-old child with seizures shows peripheral lesions that involve cortical gray matter and subcortical white matter. There is also a lesion of the left caudate nucleus. B. There are bilateral thalamic lesions on this FLAIR image of a 3-year-old child. Additional areas of mild hyperintensity indicates widespread involvement of the basal ganglia, cortical gray matter, and subcortical white matter. C. Multiple well-defined hyperintense white matter foci are present on this T2-weighted image of a 6-year-old boy. D. This 2-year-old girl has extensive hyperintensity and enlargement of the thalami and basal ganglia.

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2. Acute hemorrhagic encephalomyelitis

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Figure 17-2

Acute hemorrhagic encephalomyelitis.

A. This 5-year-old child has bilateral thalamic lesions that are hyperintense on this T2-weighted image. There is a hypointense focus within the left thalamic lesion. B. A T1-weighted image shows a focus of hyperintense hemorrhagic necrosis within the zone of hypointense edema in the left thalamus. C. An ADC map image demonstrates a ring of restricted diffusion surrounding the hemorrhagic focus. The remainder of the thalamus is hyperintense, indicating edema with increased diffusion.

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3. ADEM and optic neuritis

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Figure 17-3

ADEM and optic neuritis.

This 5-year-old boy presented with acute onset of right-sided eye pain and vision loss. He had recently recovered from an Epstein-Barr virus infection. A. An axial FLAIR image shows enlargement and hyperintensity of the right optic nerve. Cortical gray matter in the temporal lobes is thickened and mildly hyperintense. B, C. Coronal and axial FLAIR images show multiple areas of white matter involvement, predominantly subcortical.

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4. ADEM

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Figure 17-4

ADEM.

There are multiple small foci of homogeneous contrast enhancement (arrows) in the cortical gray matter and subcortical white matter on this T1-weighted image with IV gadolinium.

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5. ADEM

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Figure 17-5

ADEM.

A. A FLAIR image of a 12-year-old boy shows subtle hyperintensity in the cortical gray matter and subcortical white matter in the medial aspects of the left temporal and occipital lobes (arrows). B. There is intense contrast enhancement.

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6. Multiple sclerosis

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Figure 17-6

Multiple sclerosis.

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