Differential Diagnosis for Nonspecific Foci of T2/FLAIR Hyperintensity in Frontal White Matter
- Single Most Likely Diagnosis
- Small vessel disease: This is the most common cause of nonspecific white matter hyperintensities, especially in older adults, due to chronic small vessel ischemic changes.
- Other Likely Diagnoses
- Multiple sclerosis: Although the lesions are nonspecific, multiple sclerosis should be considered, especially if the patient is young and has a history of neurological symptoms.
- Migraine: Some patients with migraines may have white matter hyperintensities, possibly related to migraine-related vasculopathy.
- Chronic hypertension: Uncontrolled hypertension can lead to small vessel disease and subsequent white matter changes.
- Do Not Miss Diagnoses
- Acute disseminated encephalomyelitis (ADEM): A rare but potentially life-threatening condition that can present with white matter changes and should be considered, especially if the patient has a recent viral infection or vaccination.
- Progressive multifocal leukoencephalopathy (PML): A rare and often fatal condition caused by the JC virus, typically seen in immunocompromised patients.
- CNS lymphoma: Although rare, CNS lymphoma can present with white matter changes and should be considered, especially if the patient has a history of immunosuppression.
- Rare Diagnoses
- Leukoaraiosis: A rare condition characterized by extensive white matter changes, often associated with aging and hypertension.
- CADASIL (Cerebral Autosomal Dominant Arteriopathy with Subcortical Infarcts and Leukoencephalopathy): A rare genetic disorder that affects the blood vessels in the brain, leading to white matter changes and subcortical infarcts.
- Mitochondrial disorders: Some mitochondrial disorders, such as MELAS (Mitochondrial Encephalomyopathy, Lactic Acidosis, and Stroke-like episodes), can present with white matter changes.