What are the differential diagnoses for a brain MRI that shows both juxtacortical and periventricular lesions?

Question:
What are the differential diagnoses for a brain MRI that shows both juxtacortical and periventricular lesions?

Answer:
There are a wide variety of vascular and inflammatory diseases that are associated with juxtacortical and periventricular “lesions” or, to use a more accurate label, T2 hyperintensities.
It is important to correctly define these lesions or T2 hyperintensities as follows:

1. A periventricular lesion must abut the ventricular surface. This means there can not be even a small gap between the lesion edge and the ventricular surface. The ventricule is the space in the middle of the brain where spinal fluid is formed and circulates.
2. The most specific juxtacortical lesion is a leukocortical lesion with a U or hook shape that follows the contour of a cortical gyrus. Leukocortical means that the lesion involves both the cortex and the underlying white matter. To be truly juxtacortical the lesion must be immediately adjacent to (touching) or involving the cortex. Otherwise the lesion is better referred to as a subcortical white matter lesion. Subcortical white matter lesions are not very specific for any disorder.

Even though this MRI criteria is more specific, it is not diagnositc. The diagnosis is only assured in the correct clinical setting.

Hope this helps
Revere (Rip) Kinkel MD
Professor of Clinical Neurosciences
Director of the Multiple Sclerosis Program
Clinical Neurosciences Director
University of California San Diego