Codes

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Diagnostic Pearls

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Differential Diagnosis & Pitfalls

• Migraine with aura
• Early onset Alzheimer disease
• Depression
• Bipolar disorder
• Hypercoagulability (inherited or acquired)
• Ischemic stroke

• Acquired small vessel ischemic disease (due to vascular risk factors)
• Binswanger disease
• Progressive multifocal leukoencephalopathy (in immunosuppressed patients)
• Human immunodeficiency virus (HIV) encephalopathy (in patients with AIDS)
• Neurosyphilis
• Multiple sclerosis
• Primary angiitis of the central nervous system (CNS)
• Lupus cerebritis
• Traumatic brain injury / diffuse axonal injury
• Radiation-induced leukoencephalopathy (in patients with a prior history of brain radiation)
• Methotrexate-induced leukoencephalopathy (in patients with prior history of exposure to methotrexate)
• Gliomatosis cerebri (typically will present with asymmetrical changes on brain MRI)
• CNS lymphoma

• Fabry disease
• Adult-onset autosomal dominant leukodystrophy
• X-linked adrenoleukodystrophy
• Metachromatic leukodystrophy
• Mitochondrial encephalomyopathy, lactic acidosis, and stroke-like episodes (MELAS)
• Cerebral autosomal recessive arteriopathy with subcortical infarcts and leukoencephalopathy (CARASIL)
• Cathepsin A-related arteriopathy with strokes and leukoencephalopathy (CARASAL)

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Management Pearls

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Therapy

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References

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