An early phase of wallerian degeneration in a 20-year-old woman with subacute infarction (72 h after onset). a T2-weight-ed image shows hyperintense lesion involving the right basal ganglia, the posterior limb of the internal capsule and corona radiata, representing an acute infarct. b T2-weighted image shows hyperintense lesion along the ipsilateral corticospinal tract (arrow) and substantia nigra (arrowheads) in the cerebral peduncle, which represents wallerian and transneuronal degeneration secondary to the infarction in the right basal ganglia and corona radiata. c d DW image shows a hyperintense spot in the right cerebral peduncle associated with decreased ADC, which may represent axonal swelling in the early phase of wallerian degeneration. e Another case of the early phase of wallerian degeneration. Histopathology shows axonal swelling as an enlarged axon in the corticospinal tract in the brain stem (arrows) (hema-toxylin-eosin stain, original magnification X200)
Figure 4.12 a-f
Figure 4.12 a-f
Multiple sclerosis in a 36-year-old woman with subacute onset of progressive aphasia. a T2-weight-ed image shows a hyperintense lesion in the periventricular white matter (arrow). b Gadolinium T1-weighted image with magnetization transfer contrast shows rim enhancement of this lesion. c DW image shows a combination of moderately hyperintense and significantly hyperintense lesions. d On ADC, the moderately hyper-intense lesion on DW image has an increased ADC,which may represent demyelination (arrows), while the markedly hyperintense lesion on the DW image, with decreased ADC, may represent intramyelinic edema (arrowheads). e Another case. Histopathology shows that intramyelin-ic edema (arrows) is located in the periphery of a plaque (PL) (Luxol fast blue PAS stain,original magnification x40).f Magnification of (e). Intramyelinic edema is seen along the myelin sheaths (arrows) (Luxol fast blue PAS stain,original magnification x200). (From )
Phenylketonuria in a 36-year-old male. a T2-weighted image shows hyperintense lesions in the periventricular white matter (arrows). b DW image shows these lesions as hyperintense. c These hyperin-tense lesions have decreased ADC, representing cytotoxic edema, especially intramyelinic edema. d 3-month follow-up MRI shows complete resolution of these lesions with clinical improvement
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