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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: Spine
Spinal Dural Arteriovenous Fistula vs. Venous Congestive Myelopathy
Dae Chul Suha
aDepartments of Radiology and Research Institute of Radiology
University of Ulsan
College of Medicine
Asan Medical Center
Seoul, Korea
Kwang Kuk Kimb
bDepartment of Neurology
University of Ulsan
College of Medicine
Asan Medical Center
Seoul, Korea
Venous congestive myelopathy (VCM) often results from impaired venous outflow secondary to a spinal arteriovenous malformation.1,2 Foix-Alajouanine syndrome, also known as subacute necrotizing myelopathy or angiodysgenetic necrotizing myelopathy, is the term formerly used to describe this progressive myelopathy. One of the causes is known to be spinal dural arteriovenous fistula (SDAVF).3
McKeon et al. described … 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 >>
Hirayama Disease: A Short Review
For some reason, lately we have gotten several requests to perform flexion MRI studies of the cervical spine to rule out Hirayama disease. Here is a short presentation that one of our fellows, Dr. Janica Walden, prepared on this topic.
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 >>
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 >>
Educational Presentation: Subacute Combined Degeneration of Spinal Cord
Here is a short and concise presentation on the etiology, imaging findings and treatment for subacute combined degeneration of the spinal cord. It was prepared by one of our neuroradiology fellows, Dr. Ali Nasim, for our weekly interesting case conference.… Continue reading >>
CT-Guided Cervical Nerve Root Blocks
I have three questions for radiologists who perform spinal injections for pain management.
1. How many people regularly do cervical nerve root blocks?
2. Are you using CT or conventional fluoro?
3. If you are using CT, do you use contrast to confirm needle position?
It would be great for people to comment on the blog, but you can also email me directly.
Thanks!
jenny.hoang@duke.edu… Continue reading >>
AJNR’s New Special Collection Provides Backdrop to Vertebroplasty Controversy
The recent publication of two prospective, randomized vertebroplasty trials in the New England Journal of Medicine has garnered lively debate about the benefits of this procedure. The American Journal of Neuroradiology’s latest Special Collection “Percutaneous Vertebroplasty” documents the seminal research leading up to these latest studies and serves as an excellent foundation for spinal augmentation research.
“Few would argue that percutaneous vertebroplasty announced its birth and found its voice on the pages of AJNR. No other publication has been more crucial to the discussion, dissection, and dissemination of technical and clinical research as it relates to this … Continue reading >>
Aunt Mickey (They Look the Same until You Undress Them). Myxopapillary Ependymoma or Something Else?
This young male presented with chronic but progressive low back pain and lower extremity weakness. MR imaging of the lumbar spine with contrast showed a lesion, intradural/extramedullary, extending from T12 to L4. The lesion “expanded” the spinal canal and produced significant remodeling (scalloping) of the posterior vertebral bodies. The mass had mostly low T1 signal pre contrast, mostly high T2 signal and enhanced after gadolinium. Is it a large myxopapillary ependymoma?
Analysis of axial images showed that the mass involved the spinal canal but extended out into the paraspinal regions, including the right psoas muscle, via several neural foramina. The … Continue reading >>
Mass in Septum Pellucidum
Does anyone know what this mass could be? It was biopsied 2 years ago and pathology reported it as “normal brain tissue”.
As you can see, the lesion is hyperintense on T2, hypointense on T1 and does not enhance. No calcifications are present and no there is no restricted diffusion .
The patient is 25 year old and has loss of short term memory and seizures.
Any input into the nature of the mass is welcome.… Continue reading >>