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Spinal Cord Herniation • 10,146 views
This is a case for Prof. Dr. Dillon. It is in press by our neurosurgeons and us, for the use of Duragen. Idiopathic herniation of the thoracic spinal cord: a case report and technique note. U...
Neuro Protocols • 7,715 views
Alisa Gean is doing a great job getting a group together to share and collaborate neuro protocols. This would be a great place from members to share protocols, and open a discussion about the best ima...
Possible SIH with Spinal Subdural Hygroma, What Next? • 6,341 views
[caption id="attachment_602" align="aligncenter" width="407" caption="Sag T1. Tonsils are not particularly low and no sagging of the base of the brain."][/caption] [caption id="attachment_603" alig...
Cervical Spine Nomenclature • 5,060 views
The ASNR/ASSR nomenclature document was specific for the lumbar spine. I would be interested in your opinion on the correct terminology for cervical spondylosis: what terms and why. Specifically, t...
Brachial Plexus MRI Protocol • 4,646 views
BP MRI Protocol Fall is upon us and so is the lecturing season! Like years before, this Fall I will be giving my brachial plexus lecture several times and the most commonly asked question by the au...
Intracranial Hypotension: Advice on Best Treatment • 4,485 views
Middle age female patient diagnosed with Spontaneous intracranial hypotension. Has multiple (approx 23) perineural cysts. Has undergone several blood patches and artificial CSF infusions without rel...
Embolization of Brain Arteriovenous Malformations for Cure • 4,180 views
The editorial comment in the AJNR of Jan 09 by Jayaraman and Cloft is worthy of careful scrutiny, I believe. Although in my personal experience with Onyx and NBCA, final cure rates of brain AVMs from ...
Aunt Mickey (They Look the Same until You Undress Them). Internal Capsule Infarct or Something Else? • 3,892 views
This 30 year old hypertensive female smoker presented with acute onset of right hemiparesis. Her history also included OCP use and dyslipidemia. MRI demonstrated an acute infarct in the posterior limb...
Liver Hemangiomas and Vascular Lesions of the Brain • 3,871 views
[gallery] I have a patient with 15 large liver hemangiomas and two partly calcified lesions in brain. Does anyone know of associated liver hemangiomas and vascular lesions in the brain?
More on DWI of Head and Neck Lesions • 3,870 views
Yesterday I wrote a short comment in the utility of DWI in the evaluation of head and neck lesions. While reading cases in the afternoon I came across a new patient with a retinoblastoma. This pa...
Category Archives: Brain
Familial Multiple Cavernous Angiomas: Screening of a Family Over Three Generations
INTRODUCTION
Cavernous angiomas belong to a group of intracranial vascular malformations that are developmental malformations of the vascular bed. These congenital abnormal vascular connections frequently enlarge over time. The lesions can occur on a familial basis. Patients may be asymptomatic, although they often present with headaches, seizures, or small parenchymal hemorrhages.
In most patients cavernous angiomas are solitary and asymptomatic. In recent times, increasing MR imaging has detected several such asymptomatic cases and has prompted a study into the genetics and natural history of this condition.
It is now known that cavernous angiomas have a genetic basis. Familial forms … Continue reading >>
How to report Transient Splenial Lesion and How Often to Follow It Up?
A 39-year-old man with history of tingling sensation on the left half of Face.
MRI revealed a solitary lesion in the splenium of the corpus callosum, hyperintense on T2/FLAIR and hypointense on T1W images. There is diffusion restriction.
This lesion was presumed demyelinating in view of h/o upper respiratory tract infection. At 6-week follow up MRI the lesion resolved completely.
Various etiologies have been reported for transient splenial lesions like:
- Seizures
- Sudden withdrawal of antiepileptic drugs
- Brain infarction
- Multiple sclerosis
- Cerebral trauma
- Neoplasm
- Adrenoleukodystrophy
- AIDS dementia complex
- Infections like influenza, measles, herpes, Salmonella, mumps, adenovirus, varicella zoster, Legionnaires disease,
Definition of PH2, Re: Blood-Brain Barrier Permeability Assessed by Perfusion CT…
I read with great interest the editor’s choice in the Jan issue of AJNR ”Blood-Brain Barrier Permeability Assessed by Perfusion CT Predicts Symptomatic Hemorrhagic Transformation and Malignant Edema in Acute Ischemic Stroke” by Hom, Dankbaar, Soares, and colleagues. The article presented promising data for the combined use of clinical metrics and dynamic perfusion/permeability data to predict symptomatic HT and malignant edema.
However, I want to bring attention to the authors’ representative figure 1 (page 46). The follow-up hemorrhage 23 hours later appears on this single slice to be petechial in nature, and not a space occupying hematoma as stated by the authors, and certainly not … Continue reading >>
Aunt Mickey (They Look the Same until You Undress Them). Posterior Fossa Tumor or Something Else?
51-year-old male with no significant past medical history presented with 3+ months H/O intermittent dizziness, intermittent headaches, difficulty going down stairs and 3+ days H/O tingling and numbness on the right side of face, right hand and foot. MRI revealed increased T2 signal and swelling of the entire pons including the middle cerebellar peduncles with effacement/obliteration of the prepontine and CP angle cisterns. Center of the lesion was heterogeneously T2 hypointense and showed heterogeneous contrast enhancement, small focus of diffusion restriction, focal area of increased CBV and high choline to creatine ratio (2.18) & a tall lactate peak on MR … Continue reading >>
Annotated Bibliography #10
1. Marawar S, Girardi FP et al. National Trends in Anterior Cervical Fusion Procedures. Spine 2010;35:1454–1459. An 8-fold increase in prevalence and a similar increase in utilization of ACDF in the study population over a 15-year period (771, 932 discharges following ACDF were found). Not exciting reading, but a nice update on the tremendous utilization of cervical ACDF.
2. U-King-Im JM, Fox AJ et al. Characterization of Carotid Plaque Hemorrhage: A CT Angiography and MR Intraplaque Hemorrhage Study. Stroke 2010;41:1623-1629. The authors did not find mean plaque density to be a useful factor for prediction of MR … Continue reading >>
Open letter in response to NYT article from July 31, 2010 “The Radiation Boom After Stroke Scans, Patients Face Serious Health Risks” By WALT BOGDANICH
posted by Michael H. Lev and Max Wintermark
Every year in the United States, more than three quarters of a million people have a stroke, and approximately every 3 minutes someone dies from a stroke. A significant portion of stroke victims are young, and left with a devastating handicap for the rest of their lives. The monetary and societal costs of stroke represent a major economic challenge to the healthcare system. With stroke – as with heart attack – rapid treatment is essential to limit the extent of irreversible brain injury (“time-is-brain”), and rapid determination of the cause and degree … Continue reading >>
SIH (Spontaneous intracranial hypotension). Why should we ban “CSF hypovolemia” ? Because it’s a misnomer
Spontaneous intracranial hypotension (SIH) is now a fairly well known syndrome. Leakage of CSF is considered the pathogenetic factor, even in cases in which it is not demonstrated.
The loss of CSF volume explains the usual complaint of orthostatic headache, relieved by lying down, and the characteristic MRI findings: 1) thickening of the dura, enhancing after contrast medium administration, 2) subdural fluid collections, 3) sagging of the brain, 4) dilatation of the venous structures, which includes enlargement of the dural sinuses and veins, enlargement of the pituitary gland, and, in the spinal canal, engorgement of the epidural plexuses. All these … Continue reading >>
Annotated Bibliography #7
1. Samartzis D et al. Atlantoaxial Rotatory Fixation in the Setting of Associated Congenital Malformations. Spine 2010;35:E119–E127. New subtypes to the Fielding and Hawkins classification scheme for atlantoaxial rotatory fixation should exist to account for variations in anatomy and the existence of congenital anomalies/malformations.
2. Kim KH et al. Adjacent Segment Disease After Interbody Fusion and Pedicle Screw Fixations for Isolated L4–L5 Spondylolisthesis. Spine 2010;35:625–634. A low postoperative segmental lordotic angle, especially less than 20°, at index level was related with development of clinical ASD in both isthmic and degenerative spondylolisthesis patients.
3. Ribas GC .The cerebral … Continue reading >>
Please Help Me with This Case!
An 11-year-old boy was involved in a car accident and presented in a semicomatous state.
Clinically he was diagnosed as having sustained a diffuse axonal injury and was treated conservatively.
A brain MRI was performed one month following injury and a repeat one 1 year later.
Susceptibility WI at the one month interval showed multiple microhemorrhages in both frontal lobes.
The one year follow-up MRI showed diffuse, symmetric, confluent hyperintensities in the periventricular WM and these findings were not present on the initial MRI.
The question is whether the WM changes seen at the one-year follow up study are related to the diffuse axonal injury. … Continue reading >>
AJNR’s New Special Collection and Podcast Survey Brain Tumor Imaging
“Brain Tumor Imaging, Volume 1: Pretherapy” is the latest Special Collection from the American Journal of Neuroradiology. Distilling the best of the many articles related to brain tumor imaging that appear in the pages of AJNR posed a daunting task, but Editor-in-Chief Mauricio Castillo knew that Collection Editor Soonmee Cha of the University of California, San Francisco would be successful. “Dr. Cha is a respected investigator, a contributor of high quality and clinically relevant articles to AJNR and other journals, and a member of our Editorial Board,” he explained. Dr. Cha chose to categorize and present this compilation of research … Continue reading >>