Table 1.
Clinical form of MBS | Predominant symptoms | Clinical differentials and their MRI findings |
---|---|---|
Acute MBS | Mental confusion, disorientation, neurocognitive deficits, and seizures | (1) Wernicke encephalopathy
Symmetric involvement of medial thalami, mammillary bodies, tectal plate, and periaqueductal grey matter; hypointense on T1WI; hyperintense on T2W and FLAIR images. Few cases with cortical involvement restricted to motor and premotor areas. |
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Chronic MBS | Chronic dementia | (1) Alzheimer disease
Extreme hippocampal and medial temporal lobe atrophy, severe global atrophy in end-stage disease. (2) Multi-infarct dementia (i) Diffuse white matter disease with large confluent lesions (hypointense on T1WI and hyperintense on T2W and FLAIR images) affecting at least 25% of white matter, mainly in the periventricular regions. (ii) Multiple lacunar infarcts in frontal white matter, thalami, and basal ganglia. (iii) Strategic infarcts: involving Parieto-temporo-occipital association areas, angular gyrus (middle cerebral artery territory), paramedian thalamic, and inferior medial temporal lobe (posterior cerebral artery territory). (3) Frontotemporal lobar degeneration (Pick's) disease: Pronounced atrophy of frontal and/or temporal lobes. |