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. 2016 Dec;6(6):506–514. doi: 10.1212/CPJ.0000000000000289

Figure 2. Abnormal sequence of myelination in HEMS.

Figure 2

Silver staining of a sagittal neonatal brain slice demonstrates presence of myelin in the brainstem and also already in the subcortical white matter of the precentral gyrus (A). Silver staining of an axial slice of a 4-month-old infant shows myelin in the external optic radiation (red arrow, D). Axial T2-weighted images of 2 patients with HEMS (B and E) demonstrate lack of normal myelin signal in the brainstem (B) and the optic radiation (red arrow, E). The corresponding images from a child with typical Pelizaeus-Merzbacher disease (C and F) show a much better myelinated brainstem (C) and optic radiation (red arrow, F). HEMS = hypomyelination of early myelinating structures. Panels A and D are used with permission from Thieme Publishers, Georg Thieme Verlag KG. Flechsig P. Anatomie des menschlichen Gehirns und Rückenmarks auf myelogenetischer Grundlage. Leipzig: Thieme; 1920.