MedLink Neurology Podcast is delighted to feature selected episodes from BrainWaves, courtesy of James E Siegler MD, its originator and host. BrainWaves is an academic audio podcast whose mission is to educate medical providers through clinical cases and topical reviews in neurology, medicine, and the humanities, and episodes originally aired from 2016 to 2021. Originally released: January 9, 2020 The common teaching is that restricted diffusion on MRI indicates stroke—acute cerebral infarction--when, more specifically, the changes on DWI and ADC indicate impairment in the random movement of water molecules in a given tissue. With slower movement, as in energy-depleted tissues with failing ATP-dependent sodium/potassium channels, high cellularity, or a highly viscous extracellular space, there is restricted diffusion (of water) and a corresponding bright signal on DWI. These and other considerations are the focus of this week's episode of BrainWaves. Produced by James E Siegler. Music courtesy of Uncanny and Kevin McLeod. Sound effects by Mike Koenig. BrainWaves' podcasts and online content are intended for medical education only and should not be used for clinical decision-making. Be sure to follow us on Twitter @brainwavesaudio for the latest updates to the podcast. REFERENCES Aliaga ES, Barkhof F. MRI mimics of multiple sclerosis. Handb Clin Neurol 2014;122:291-316. PMID 24507523 Filippi M, Iannucci G, Cercignani M, Assunta Rocca M, Pratesi A, Comi G. A quantitative study of water diffusion in multiple sclerosis lesions and normal-appearing white matter using echo-planar imaging. Arch Neurol 2000;57(7):1017-21. PMID 10891984 Hegde AN, Mohan S, Lath N, Lim CC. Differential diagnosis for bilateral abnormalities of the basal ganglia and thalamus. Radiographics 2011;31(1):5-30. PMID 21257930 Maier SE, Sun Y, Mulkern RV. Diffusion imaging of brain tumors. NMR Biomed 2010;23(7):849-64. PMID 20886568 McKinney AM, Short J, Truwit CL, et al. Posterior reversible encephalopathy syndrome: incidence of atypical regions of involvement and imaging findings. AJR Am J Roentgenol 2007;189(4):904-12. PMID 17885064 Meyer JR, Gutierrez A, Mock B, et al. High-b-value diffusion-weighted MR imaging of suspected brain infarction. AJNR Am J Neuroradiol 2000;21(10):1821-9. PMID 11110533 Roberts TP, Rowley HA. Diffusion weighted magnetic resonance imaging in stroke. Eur J Radiol 2003;45(3):185-94. PMID 12595102 Starkey J, Kobayashi N, Numaguchi Y, Moritani T. Cytotoxic Lesions of the corpus callosum that show restricted diffusion: mechanisms, causes, and manifestations. Radiographics 2017;37(2):562-76. PMID 28165876 Steiner I, Budka H, Chaudhuri A, et al. Viral meningoencephalitis: a review of diagnostic methods and guidelines for management. Eur J Neurol 2010;17(8):999-e57. PMID 20236175  We believe that the principles expressed or implied in the podcast remain valid, but certain details may be superseded by evolving knowledge since the episode’s original release date.

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