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Spinal Cord Herniation • 10,723 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 • 8,067 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? • 6,657 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...
Brachial Plexus MRI Protocol • 5,347 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...
Cervical Spine Nomenclature • 5,217 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...
Intracranial Hypotension: Advice on Best Treatment • 5,039 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 • 4,239 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 ...
Liver Hemangiomas and Vascular Lesions of the Brain • 4,212 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?
Aunt Mickey (They Look the Same until You Undress Them). Internal Capsule Infarct or Something Else? • 4,144 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...
More on DWI of Head and Neck Lesions • 3,979 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
CT perfusion for stroke: 2 questions
1. I have read that it is OK to do the CT Perfusion study either before or after the CTA (AJNR Am J Neuroradiol 2008 29: e23-e30). I have always done the CTA first, but I would like to know what other people are doing, and what the relevant considerations are.
2. Is 80 the optimal kVp for the perfusion study?
Thanks… Continue reading >>
Aunt Mickey (They Look the Same until You Undress Them). Meningioma or Something Else?
73 year old lady presented with six weeks history of odd behavior, increasing apathy, expressive aphasia, and mild headache. An MRI including diffusion and perfusion imaging was obtained. MRI revealed a T1 hypointense (to cortex) and slightly T2 hyperintense (to cortex) extra-axial mass in the left frontal region. There were multiple central T2 hyperintense areas. On post contrast T1 weighted sequence, there was intense enhancement of the mass except the central T2 hyperintense areas.There were prominent diffusion restriction and high rCBV in most parts of the tumor in diffusion and perfusion imaging respectively.
At this point, what is your diagnosis? … Continue reading >>
Annotated Bibliography #5
1. Focal cortical dysplasia type II: biological features and clinical perspectives. Lancet Neurol 2009; 8: 830–43
Very nice review article with histopathology, imaging and helpful graphics
2. Neuro-Behçet’s disease: epidemiology, clinical characteristics, and management. Lancet Neurol 2009; 8: 192–204.
Behcet’s disease is a multisystem relapsing inflammatory disorder of unknown cause. This review covers CNS parenchymal and nonparenchymal manifestations, as well as peripheral and uncommon variants.
3. The protective status of subtotal obliteration of arteriovenous malformations after radiosurgery: significance and risk of hemorrhage. Neurosurgery 65:709–718, 2009
Important paper evaluating the risk of AVM’s which show only early draining vein but no … Continue reading >>
Aunt Mickey (They Look the Same until You Undress Them). Meningioma or Something Else?
51 year old lady presented with headache and gait disturbances. An MRI including perfusion imaging was obtained. MRI revealed an extra-axial, dural based mass of the posterior fossa which was isointense to gray matter on T1 weighted sequence and hyperintense to gray matter on T2 weighted sequence. There was no diffusion restriction. On T2 weighted sequence, there was wedge shaped area of perilesional T2 hyperintensity extending transversely and superiorly to involve vermis. With contrast, the lesion showed intense homogenous enhancement. On perfusion study, there was considerable increase in rCBV. Preoperatively it was diagnosed as meningioma and the patient was scheduled … Continue reading >>
Aunt Mickey (They Look the Same until You Undress Them). Lhermitte-Duclos or Something Else?
A young man presented with ataxia. Brain contrast enhanced MRI was done including DWI and perfusion. T2WI showed a mixed intensity lesion in the inferior right cerebellar hemisphere which contained some “dark stripes”. DWI ADC map show restricted diffusion centrally. After contrast the lesion enhanced in a striped fashion and perfusion showed low rCBV (see below). Llermitte-Duclos disease was considered in the differential diagnosis.
Further questioning of patient disclosed that the symptoms had had a sudden onset 7 days earlier. The diagnosis of subacute infarction of the right posterior inferior cerebellar artery territory was considered as the most likely cause … Continue reading >>
Crossed Cerebellar Diaschisis
A 41-year-old female with history of migraine presented to the ED with acute onset of aphasia. In addition to the aphasia, there was numbness and tingling in the right arm and face. Patient demonstrated expressive aphasia and was not able to answer questions posed in the ED. Gadolinium MR perfusion images demonstrated decreased relative cerebral blood flow (top) in the left parietal/occipital lobes and increased time-to-peak (bottom) in the contralateral cerebellar hemisphere. Although crossed cerebellar diaschisis (CCD) is seen mostly on radiotracer studies (hypometabolism on PET studies), it was nicely demonstrated in our patient. CCD occurs more often after supratentorial … Continue reading >>
Neonatal Pituitary Gland
This is a one month-old female with congenital hypothyroidism, hypoplasia of the thyroid gland, elevated TSH (eight times normal value), elevated FSH and LH (four times normal values), normal GH, without diabetes insipid. She is now being treated for the hypothyroidism, and we are waiting for hormonal follow-up; MRI follow-up in three to six month follow-up.
Has anyone an explanation for the focal bright spot on T1-weighted images in the cranial portion of the pituitary stalk, just down the median eminence, in the presence of a normal neurohypophysis?
Is it an “ectopic” adenohypophysis?
Is this a thin pituitary stalk in … Continue reading >>
CT Still Useful for Retinoblastoma?
The article “Is CT Still Useful in the Study Protocol of Retinoblastoma?“, published July 17 in the Publication Preview section of AJNR, confirms that even when high-field MRI is not available, CT can be avoided in the workup of the patient with suspected retinoblastoma, when MRI is combined with a good ophthalmoscopic exam and ocular sonography. Certainly with 3D imaging at 3T, the detection rate with MRI could reasonably be expected to be even higher, allowing us to “Image Gently” and more accurately.
The authors state that “CT is still the method of choice for detecting intraocular calcium … Continue reading >>
Exercise and Healthy Brains
In reading the newly e published article in the AJNR “The Effect of Exercise on the Cerebral Vasculature of Healthy Aged Subjects as Visualized by MR Angiography” ( Posted on July 9th), there is positive feedback for those who exercise regularly. But does good plumbing (i.e. the cerebral vasculature), equate with successful aging? Since there have been suggestions that ongoing mental challenges such as solving math problems or completing Sudoku puzzles might be of significant benefit in combating age related mental decline, does anyone think that redirecting a portion of a one hour of physical exercise to mental … Continue reading >>
Strange Lesion
This 51 year old male patient has a right hemiparesis and progressive brainstem dysfunction. The temporal lesion is probably a low grade tumor, but what about the brain stem lesion??? Could it be a paraneoplastic encephalitis or a brainstem gliomatosis? Any other suggestions?… Continue reading >>