E2039. What’s the Matter with the White Matter: A Case-Based Review of Intracranial White Matter Lesions
  1. Conan Liang; University of California, Irvine
  2. Simrunn Girn; University of California, Irvine
  3. Eleanor Chu; University of California, Irvine
  4. Jennifer Soun; University of California, Irvine
  5. David Floriolli; University of California, Irvine
  6. Anton Hasso; University of California, Irvine
  7. Edward Kuoy; University of California, Irvine
White matter lesions are often encountered on magnetic resonance (MR) brain imaging, from nonspecific lesions that are frequently attributed to likely chronic microvascular ischemic change to more ominous processes such as infectious or neoplastic etiologies.

Educational Goals / Teaching Points
The goal of this exhibit is to discern white matter signal abnormalities that do not require further workup (terminal zones of myelination, ependymitis granularis, and chronic microvascular ischemic changes) from those that are related to underlying disease processes that may warrant further investigation and treatment. This exhibit will focus on potential patterns of involvement in the appropriate clinical setting to help narrow the differential diagnosis.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
Through a case-based format, this exhibit will explore various white matter disease processes with important clinical clues and imaging findings to arrive at the diagnosis. Sample entities covered include infectious processes (cryptococcus, HIV encephalitis), inflammatory processes [autoimmune glial fibrillary acid protein (GFAP) astrocytopathy, multiple sclerosis], vasculopathy [cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL), Susac syndrome], neoplasm (lymphoma), and miscellaneous [multinodular and vacuolating neuronal tumors (MVNT), posterior reversible encephalopathy syndrome (PRES), cytotoxic lesions of the corpus callosum (CLOCCs), osmotic demyelination syndrome] etiologies.

It is important to recognize imaging features in the context of the clinical picture to discern between white matter lesions that do not require further workup from those that warrant further investigation.