Symmetrical cerebral T2 hyperintensities

Last revised by dr branca damiano on 18 Jun 2022

Symmetrical cerebral T2/FLAIR hyperintensities are seen in a broad range of pathologies. The differential depends essentially on the location of the lesions.

Symmetrical corticospinal tract lesions
  • amyotrophic lateral sclerosis
    • symmetrical T2/FLAIR hyperintensities along the corticospinal tract from the cortices extending inferiorly to the brainstem and finally into the anterolateral column of the spinal cord
Symmetrical central tegmental tract lesions
Symmetrical basal ganglia lesions
Symmetrical thalamic and mamillary bodies lesions
Symmetrical pontine lesions
Symmetrical middle cerebellar peduncle lesions

Please refer to our article on the middle cerebellar peduncle sign for the differentials of symmetrical lesions in this region.

Symmetrical temporal or insular lesions
Symmetrical cerebellar nuclei lesions
  • Leigh syndrome
    • may involve the dentate nuclei, inferior cerebellar peduncles, periaqueductal grey matter, medulla, brainstem, midbrain, basal ganglia, substantia nigra, and thalami

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Cases and figures

  • Case 1: ALS
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  • Case 2: central tegmental tract T2 hyperintensity
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  • Case 3: carbon monoxide poisoning
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  • Case 4: methanol poisoning
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  • Case 5: hypoglycemic encephalopathy
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  • Case 6: uremic encephalopathy
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  • Case 7: osmotic demyelination syndrome
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  • Case 8: MCP sign
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  • Case 9: herpes simplex encephalitis
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  • Case 10: Leigh disease
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  • Case 11: Wilson disease
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  • Case 12: Wernicke encephalopathy
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  • Case 13: LBSL
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