Cortical Enhancement



Cortical Enhancement


Karen L. Salzman, MD



DIFFERENTIAL DIAGNOSIS


Common



  • Cerebral Infarction, Subacute


  • Herpes Encephalitis


  • Hypotensive Cerebral Infarction


  • Status Epilepticus


  • Acute Hypertensive Encephalopathy, PRES


  • Cerebritis


Less Common



  • Malignant Gliomas


  • Vasculitis


  • Hypoglycemia


Rare but Important



  • MELAS


  • Cerebral Hyperperfusion Syndrome


  • Osmotic Demyelination Syndrome


ESSENTIAL INFORMATION


Helpful Clues for Common Diagnoses



  • Cerebral Infarction, Subacute



    • Gyriform enhancement characteristic


    • Petechial hemorrhage or pseudolaminar necrosis often seen (T1 hyperintense)


    • DWI has typically normalized


  • Herpes Encephalitis



    • Predilection for limbic system


    • Typically bilateral, asymmetric; DWI +


    • Enhancement patchy or gyriform


  • Hypotensive Cerebral Infarction



    • Commonly at cortical “border zones”


    • Gyriform enhancement subacutely


  • Status Epilepticus



    • Patchy or gyriform enhancement


    • Underlying white matter (WM) spared


  • Acute Hypertensive Encephalopathy, PRES



    • Patchy cortical/subcortical PCA territory lesions in a patient with hypertension


    • Patchy enhancement, may be gyriform


  • Cerebritis



    • T2 hyperintense lesion with mass effect & patchy enhancement; DWI +


Helpful Clues for Less Common Diagnoses

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Aug 7, 2016 | Posted by in NEUROLOGY | Comments Off on Cortical Enhancement

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