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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...
Tag Archives: perfusion
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 >>
Aunt Mickey (They Look the Same until You Undress Them). Meningioma or Something Else?
A young African American woman presented with progressive left vision loss. Brain MRI with contrast and perfusion studies were obtained. The studies showed a dural-based lesion involving the lateral aspect of the left cavernous sinus which extended superiorly and crossed the planum sphenoidale to insinuate itself around the contralateral anterior clinoid process. The lesion was isointense to gray matter on T1WI, dark on T2WI, showed homogeneous gadolinium enhancement and increased rCBV on the perfusion images (see below). The provisional diagnosis of meningioma was made and the patient scheduled for surgical decompression of left optic canal.
Before surgery, a chest radiograph … 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 >>
Validation and Standardization of Stroke Perfusion Methods
CTP and MRP acquisition hardware, protocols, post processing, and interpretation vary widely between centers. If we are to use these techniques for rational triage of acute stroke patients to appropriate treatment, validation and standardization is required. I encourage all who perform such imaging to participate in the “STIR” effort, being corrdinated by Max Wintermark et al at UCSF.… Continue reading >>