ARRS 2022 Abstracts

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E1225. Beyond MS: Image Rich Case-Based Approach to the Evaluation of Non-MS Inflammatory Diseases of the Central Nervous System
Authors
  1. Madiha Aseem; Wake Forest School of Medicine
  2. Jeffrey Sachs; Wake Forest School of Medicine
  3. Carol Geer; Wake Forest School of Medicine
Background
Inflammatory diseases of the central nervous system (CNS) have many features in common and are therefore a diagnostic dilemma. Differences in treatment make it essential to arrive at the correct diagnosis. A range of tools are at the radiologist’s disposal to help make the correct diagnosis or lead the team towards the correct diagnosis.

Educational Goals / Teaching Points
This presentation highlights key differentiating features of CNS inflammatory diseases, including: 1) how to use a combination of diagnostic imaging, clinical presentation, and laboratory results; 2) knowing when to recommend ophthalmology consultation to narrow the differential; and 3). deciding when it is necessary to consider biopsy.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
Unique and differentiating features of the following demyelination lesions will be reviewed, including: acute disseminated encephalomyelitis (ADEM), neuromyelitis optica (NMO), anti-myelin oligodendrocyte glycoprotein (MOG), transverse myelitis, acute flaccid myelitis, IgG4-related disease, neurosarcoidosis, Behcet disease, Susac syndrome, cancer-associated necrotizing CNS vasculitis, inflammatory cerebral amyloid angiopathy, anti-NMDA receptor encephalitis, limbic encephalitis, and chronic lymphocytic inflammation with Pontine perivascular enhancement responsive to steroids (CLIPPERS).

Conclusion
Radiologists must be aware of the reviewed key imaging patterns, clinical manifestation, and laboratory findings of non-MS demyelinating CNS diseases, as well as when biopsy or ophthalmology consultation is required. In doing so, the radiologist will be able to provide a narrow differential diagnosis and lead the clinical team towards the correct diagnosis. This will guide early treatment and possibly avoid lasting patient morbidity.