Patchy Sclerosis on Brain MRI: MS Plaques and Differential Diagnosis
Patchy sclerosis refers to discrete, non-gyral T2/FLAIR hyperintensities—classic for **multiple sclerosis (MS) plaques** (demyelination).
Differential Diagnosis
- ADEM: Monophasic, post-infectious/vaccinal; larger, confluent lesions.
- NMOSD: Longitudinally extensive transverse myelitis + optic neuritis; aquaporin-4 IgG.
- SLE: Neuropsychiatric lupus; may mimic MS.
- PML: JC virus in immunocompromised; subcortical, non-enhancing.
- Migraine, small vessel disease, vasculitis
Diagnosis requires clinical, MRI (spatial/temporal dissemination), CSF (oligoclonal bands), and serologic correlation per McDonald criteria.
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