Putamen Lesion(s)



Putamen Lesion(s)


Karen L. Salzman, MD



DIFFERENTIAL DIAGNOSIS


Common



  • Hypertensive Intracranial Hemorrhage


  • Hypoxic-Ischemic Encephalopathy



    • HIE, Term


    • Hypotensive Cerebral Infarction


Less Common



  • Methanol Toxicity


  • Osmotic Demyelination Syndrome


  • Leigh Syndrome


Rare but Important



  • Creutzfeldt-Jakob Disease (CJD)


  • Huntington Disease


  • Parkinson Disease


  • Multiple System Atrophy


ESSENTIAL INFORMATION


Helpful Clues for Common Diagnoses



  • Hypertensive Intracranial Hemorrhage



    • Related to systemic hypertension


    • Putamen most common (60-65%)


    • Look for underlying lesion if no hypertension!


  • Hypoxic-Ischemic Encephalopathy



    • Includes anoxia, hypoxia, near drowning, & cerebral hypoperfusion injury


    • T1 & T2 hyperintense basal ganglia (BG) & cortical lesions; may affect only putamen


    • HIE, Term



      • Acquired, usually cerebral hypoperfusion


      • Profound acute HIE → deep gray matter, posterior mesencephalon, hippocampi, & peri-Rolandic cortex injury


    • Hypotensive Cerebral Infarction



      • May be isolated to deep nuclei, BG


      • Bilateral, symmetric T2 hyperintensity


      • DWI bright in acute setting!


Helpful Clues for Less Common Diagnoses



  • Methanol Toxicity



    • Putaminal necrosis, ± hemorrhage


    • Symmetric T2 hyperintense lesions


    • Often subcortical WM lesions


  • Osmotic Demyelination Syndrome



    • Extrapontine myelinolysis results in T2 hyperintensity in putamen & caudate


  • Leigh Syndrome



    • Symmetric T2 hyperintense lesions with onset in infancy/early childhood


    • Lesions primarily in brainstem, BG & WM; putamen > GP


Helpful Clues for Rare Diagnoses

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Aug 7, 2016 | Posted by in NEUROLOGY | Comments Off on Putamen Lesion(s)

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