Teaching NeuroImages Neurology Resident and Fellow Section © 2013 American Academy of Neurology Cerebral White Matter Involvement in a Patient with Bilateral.

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1, Axial T2 image in patient 1 demonstrates bilateral cystic spaces in the biparietal periventricular white matter. 2, Axial T2 image in patient 2 demonstrating.

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Presentation transcript:

Teaching NeuroImages Neurology Resident and Fellow Section © 2013 American Academy of Neurology Cerebral White Matter Involvement in a Patient with Bilateral Visual Impairment

27 yo man with bilateral decreased vision & mild headache. Exam: – Best corrected visual acuity OU: counting fingers at 4 meters. – Bilateral panuveitis & bilateral exudative macular detachment. CSF: – Mild pleocytosis: 13 cells/mm 3 (normal <5) with 93% mononuclear cells. – Normal protein (38 mg/dL; normal 10–40). – No unique oligoclonal bands. Treatment: – The patient received corticosteroid treatment. Keles et. al. Vignette

Keles et. al. Imaging 1

Keles et. al. Imaging 2

Cerebral White Matter Involvement in a Patient with Vogt-Koyanagi-Harada Syndrome VKH is a systemic autoimmune syndrome that can cause periventricular white matter FLAIR hyperintensities 1. Typically affects pigmented tissues in the eyes, inner ear, skin, and central nervous system 2. Hypothesized to be due to an autoimmune attack on melanocytes 2. Differential diagnosis of VKH includes Wegener granulomatosis, sarcoidosis, and Behçet disease 3. With prompt steroid treatment, visual prognosis can be good 2. Keles et. al.