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Forum Name: Neurology Topics

Question: Hyperintensities in supratentorial white substance


 ana - Fri Dec 11, 2009 1:43 pm

I was wondering if anybody would happen to know what could cause hyperintensities in the supratentorial white substance in an MRI. My report says there are hyperintensities in the left periventricular area and that they do not affect the corpum calloso. :(
Thank you!
 Dr.M.Aroon kamath - Sat Dec 12, 2009 9:18 am

User avatar Hi,
It is almost like trying to find the proverbial 'needle- in- the -haystack'!

Here are some guesses....

a) Ventricular diverticulae (less probable going by the amout of information provided): by far more commonly associated with obstructive than with communicating hydrocephalus. There are four areas of physiologic attenuation and weakness in the ventricular wall where "blowouts" or herniations occur under elevated pressures due to CSF obstruction (resulting in spontaneous ventriculocisternostomy).
They subsequently extend through the tentorial hiatus to the posterior fossa where
they typically present as subtentorial supracollicular CSF cysts.

b) SLE patients with neuropsychiatric (NP) involvement (NPSLE) or without neuropsychiatric involvement -(perhaps the most probable).
MRI in these patients is considered abnormal if any of the following findings were observed:
- white matter T2-hyperintense small (<10mm) punctate lesions (WMHL) located in the subcortical and/or in the periventricular regions ,
- T2-hyperintense small (<10mm) punctate lesions (GMHL) located in the grey matter of the cortex or basal ganglia.

T2-weighted WMHL localized at subcortical supratentorial
regions and/or in periventricular areas were the most frequently
observed abnormal MRI findings in SLE patients with or without neuropsychiatric involvement.


Subtentorial lesions are usually seen only in
NPSLE patients but they never seem to occur
isolated but always in association with concomitant supratentorial lesions.

Bestwishes!
 ana - Sat Dec 12, 2009 11:45 am

Could previous head trauma have caused this? I have had a head injury about a year ago, followed by a CT scan (normal), then recurrent headaches on that side of the head.
 Dr.M.Aroon kamath - Sat Dec 12, 2009 8:35 pm

User avatar Hi,
If you are referring to ventricular diverticulae, theoratically speaking, any condition that can cause an obstructive hydrocephalus should be capable of causing them.But, generally, it may take many years. Conditions such as congenital aqueductal stenosis commonly cause this as well as some tumors.
Best wishes!

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