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Free Content Subcortical U-Fibers: Signposts to the Diagnosis of White Matter Disease

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White matter diseases can be broadly separated into 3 main categories: diseases that affect myelin metabolism, diseases that result in direct damage to myelin and/or oligodendrocytes, and vascular diseases. Disorders of myelin metabolism (dysmyelinating disorders), including many inherited leukodystrophies, will generally spare the subcortical U-fibers, with their relatively slower rate of myelin turnover. However, conditions in which direct damage to previously normal myelin and/or oligodendrocytes predominates (demyelinating disorders), including multiple sclerosis and progressive multifocal leukoencephalopathy, typically demonstrate early U-fiber involvement. The purpose of this article is to demonstrate how recognizing the presence or absence of subcortical U-fiber involvement as a visible manifestation of the underlying pathophysiology in white matter disease can be extremely helpful in more confidently narrowing what may otherwise be a very broad differential diagnosis.

Learning Objective: To recognize how the presence or absence of subcortical U-fiber involvement in white matter disease can help narrow what may otherwise be a very broad differential diagnosis.
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Keywords: ADEM = acute disseminated encephalomyelitis; CADASIL = cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy; FLAIR = fluid-attenuated inversion recovery; MS = multiple sclerosis; PML = progressive multifocal leukoencephalopathy; PRES = posterior reversible encephalopathy syndrome

Document Type: Research Article

Publication date: August 1, 2018

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  • Neurographics is the peer-reviewed, bimonthly educational journal of the American Society of Neuroradiology. The journal comprises articles selected from material presented at the ASNR Annual Meeting. Neurographics also publishes other high-quality submissions that are primarily educational and have a high emphasis on a pictorial approach. Neurographics offers CME credit for reading review articles and completing quiz-based self-assessment activities. CME credit for review articles may be claimed up to 3 years after an article's publication date. Visit to view all available CME courses.
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