Learning objectives
To illustrate through representative cases, different examples of pathologies in which subcortical hypointensity can be observed in T2 weighted images.
Background
Subcortical white matter low intensity in T2 is a usually “missed” phenomenon, that can be seen in some conditions with cortical or meningeal involvement; its pathogenesis is still uncertain.
Findings and procedure details
We illustrate the subcortical T2 hypointensity presence in the following pathologies:
Meningitis and encephalitis
The presence of this phenomenonhas been described in some cases of infectious origin,specifically in viral encephalitis (being more frequent in non-herpetic cases) and in meningitis of pyogenic, cryptococcal and tuberculous origin. This finding is usually associated with leptomeningeal enhancement. In cases of encephalitis, it is associated with T2 hyperintensity of the neighboring cerebral cortex.
Subcortical white matter T2 hypointensitywould be a transitory phenomenon, reversible, like other typical findings, especially when the...
Conclusion
Subcortical low intensity is a nonspecific sign of various cortical and meningeal diseases as we have demonstrated through representative casesof meningitis, encephalitis, leptomeningealspread, hyperosmolar hyperglycemic syndrome, Sturge Weber syndrome, severe hypoxic-ischemic encephalopathy and venous sinus thrombosis.
Personal information and conflict of interest
A. Pontoni; Santiago/CL - nothing to disclose F. Lahsen; Santiago/CL - nothing to disclose P. Orellana; Santiago/CL - nothing to disclose C. A. Robles; Santiago/CL - nothing to disclose R. Núñez Flores; Santiago/CL - nothing to disclose A. Salas; Santiago/CL - nothing to disclose M. López Ramírez; Santiago, RM/CL - nothing to disclose C. Parra Albornoz; Santiago/CL - nothing to disclose A. Torres; Santiago/CL - nothing to disclose
References
1-Lee JH,Na DG,Choi KH,Kim KJ,Ryoo JW, et al: Subcortical low intensity on MR images of meningitis, viral encephalitis, and leptomeningeal metastasis. AJNR Am J Neuroradiol.2002 Apr;23(4):535-42.
2-Raghavendra S, Ashalatha R, Thomas SV, Kesavadas C. Focal neuronal loss, reversible subcortical focal T2 hypointensity in seizures with a nonketotic hyperglycemic hyperosmolar state. Neuroradiology. 2007 Apr;49(4):299-305.
3-Juhász C, Haacke EM, Hu J, Xuan Y, Makki M, Behen ME, et al.Multimodality imaging of cortical and white matter abnormalities in Sturge-Weber syndrome. AJNR Am J Neuroradiol. 2007 May;28(5):900-6.
4-Ida M,...
