Acute occipital demyelinating lesion appearing as an infarct on diffusion magnetic resonance imaging.
OBJECTIVE
To report a case of a 27-year-old woman who presented with an acute right homonymous visual field deficit due to demyelination diagnosed by postprocessing analysis of the magnetic resonance imaging (MRI).


METHODS
Observational case report.


METHODS
Magnetic resonance imaging analysis with an exponential diffusion-weighted imaging.


RESULTS
On MRI, a left occipital lesion with mild enhancement after gadolinium infusion on the T1-weighted image, bright signal with some mass effect on the T2-weighted image, and the diffusion-weighted imaging suggested a diagnosis of an acute infarct. With the use of the exponential image technique, the T2 hyperintense signal present on the diffusion study was almost completely eliminated, changing the diagnosis and treatment plan. Subsequent examinations and MRI confirmed the diagnosis of demyelinating disease.


CONCLUSIONS
In diseases such as cerebral ischemia and demyelination, MRI diffusion is often abnormal because such diseases modify the integrity of central nervous system structures. A technique that subtracts the T2 contribution to the diffusion-weighted imaging analysis supported a diagnosis of an acute demyelinating episode that was subsequently confirmed.
Fazzone
Hilary E
HE
Departments of Neuro-ophthalmology, Institute for Neurology and Neurosurgery, Beth Israel Medical Center, New York, New York 10128, USA. HF1027@hotmail.com
Lefton
Daniel R
DR
Kupersmith
Mark J
MJ
D000208:Acute Disease; D000328:Adult; D001927:Brain Diseases / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy; D002544:Cerebral Infarction / Q000175:diagnosis*; D003711:Demyelinating Diseases / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy; D003937:Diagnosis, Differential; D038524:Diffusion Magnetic Resonance Imaging; D005260:Female; D005938:Glucocorticoids / Q000008:administration & dosage; D006423:Hemianopsia / Q000209:etiology; D006801:Humans; D009778:Occipital Lobe / Q000473:pathology*; D014794:Visual Fields
D005938:Glucocorticoids