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| ISBN-13: | 9781426969683 |
|---|---|
| Publisher: | Trafford Publishing |
| Publication date: | 01/30/2012 |
| Pages: | 268 |
| Product dimensions: | 8.25(w) x 11.00(h) x 0.56(d) |
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Atlas Of Neuroradiology
200 Cases (COMMON DISEASES)By Ammar HAOUIMI
Trafford Publishing
Copyright © 2012 AMMAR HAOUIMIAll right reserved.
ISBN: 978-1-4269-6968-3
Chapter One
BRAIN
VASCULAR and TRAUMATIC
Case 1
Clinical Presentation
A 49 year-old female patient with new onset of nausea, vomiting, mild left weakness, right facial numbness, vertigo, and ataxia.
Radiological Findings
[MR Scan of brain axial FLAIR (A), and T2 (B) and sagittal T2 (C) of spine show a focal high signal intensity area of the left medulla. No other abnormality of the cerebellar hemispheres or the spinal cord. This is consistent with an acute infarct in the PICA distribution.
Diagnosis: Wallenberg Syndrome
Case 2
Clinical Presentation
An 86 year-old female patient presenting an acute dizziness, vertigo, dysarthria, the 2nd nonenhanced CT Scan (C, D) was performed 48 hours later after sudden loss of consiousness, weakness of limbs and blindness.
Radiological Findings
Nonenhanced brain CT Scan: The first brain CT Scan(A, B) done few hours after the acute onset shows normal size and density of the brainstem and both cerebellar hemispheres. The second CT Scan(C, D) done 48 hours later shows an enlarged brainstem with large central low-density area consisting with brainstem infarction.
Diagnosis: Brainstem Infarction
Case 3
Clinical Presentation
A 65 year-old female patient presented with left hemiplegia.
Radiological Findings
Brain MR, non-enhanced sagittal T1 (A), axial FLAIR (B), coronal T2 (C) and MRA-3D-TOF (D) showing a low-T1 and high-FLAIR and T2 lesion involving the right anterolateral aspect of the pons. The MRA shows complete thrombosis of the right vertebral artery.
Diagnosis: Brainstem Infarction
Case 4
Clinical Presentation
An 86 year-old male patient with acute diminution of the vision.
Radiological Findings
Plain brain CT Scan reveals a large low-density area in the right temporo-occipital region in the distribution of the posterior cerebral artery (PCA) territory with mass effect on the adjacent temporal horn. No other abnormality.
Diagnosis: PCA Territory Infarction
Case 5
Clinical Presentation
A 64 year-old female diabetic and hypertensive patient with one week history of temporo-spatial disorientation, headaches and drowsiness.
Radiological Findings
Plain brain CT Scan showing large low-attenuation areas involving both gray and white matter of the cerebellar hemispheres and occipital regions with obliteration of the cerebellar and occipital sulci and mass effect on the 4th ventricle. Note calcification of the right vertebral artery (image A).
Diagnosis: Vertebro-basilar Territory Infarction
Case 6
Clinical Presentation
A 63 year-old male patient, presented with right hemiparesis.
Radiological Findings
Nonenhanced brain CT Scan (A, B) demonstrates a large low-density area within the distribution of the superficial territory of the left middle cerebral artery (MCA) with loss of the gray-white matter differentiation and adjacent sulcal effacement. No significant ventricular compression or midline shift.
Diagnosis: Left MCA Infarction
Case 7
Clinical Presentation
A 57 year-old male patient fell while sking 2 days ago and developed acute visual deterioration with left hemiplegia.
Radiological Findings
Plain CT Scan reveals a large low-attenuation area involving the right middle cerebral artery (MCA) territory with dense MCA, containing hyperdense areas (hemorrhagic transformation) with sulcal effacement and mild mass effect on the adjacent lateral ventricle.
Diagnosis: Hemorrhagic Transformation in Acute MCA Infarct
Case 8
Clinical Presentation
A 47 male patient with no particular past-history, presenting a sudden left hemiplegia.
Radiological Findings
The first CT (A) shows a hyperattenuated linear vascular structure in the right temporal region (hyperdense MCA sign), representing thrombus formation within the vessel (early CT sign of ischemia). The second CT (B, C, D) done three days later shows a large low density area in the distribution of the MCA territory, containing hyperdense areas (hemorrhagic transformation of an ischemic infarct).
... continued, MR Scan (done four days later) sagittal T1 (D), axial FLAIR (E), coronal T2 (F) and MRA 3D-TOF (I) images show the extension of the infarct in the right MCA territory as a large area of low-T1 and high-T2 and FLAIR signal intensity, containing area of hemorrhage drawing the lentiform nucleus. The MRA shows complete thrombosis of the right internal carotid artery (ICA) and partial of M1 segment of MCA, which is supplied by the right anterior and posterior communicating arteries.
Diagnosis: Hemorrhagic Transformation of Right MCA Infarct with Complete Thrombosis of the ICA and Partially of M1-segment of the MCA
Case 9
Clinical Presentation
A 53 year-old male patient with acute onset of right hemiplegia.
Radiological Findings
MRI Scan axial FLAIR (A, B) and DWI-EPI (C, D) showing a Large area of high-signal intensity in the distribution of the left middle cerebral artery territory with effacement of the adjacent cortical sulci and mild mass effect on the left lateral ventricle. The diffusion-weighted sequence demonstrates the ischemic region as an area of low diffusion or high signal intensity.
Diagnosis: Acute Left MCA Infarction
Case 10
Clinical Presentation
An 84 year-old hypertensive female patient presented with left upper arm crural paresis and frontal signs.
Radiological Findings
Plain brain CT Scan reveals a low attenuation abnormality involving the left frontal lobe in the distribution of the anterior cerebral artery territory (ACA). Mass effect is present on the adjacent lateral ventricle with effacement of the overlying cortical sulci.
Diagnosis: ACA Infarction
Case 11
Clinical Presentation
A 52 year-old male patient with Broca's aphasia and right monoparesis.
Radiological Findings
MR Scan, sagittal T1 (A), coronal T2 (B) and axial FLAIR (C, D) showing a large low-T1 and FLAIR and high T2 signal intensity area of the left fronto-insular region in the distribution of the superficial MCA territory with cortical atrophy, surrounded by a high signal area on FLAIR images indicating gliosis and demyelinisation. Note the dilatation of the ipsilateral LV and sylvian fissure indicating and old stroke.
Diagnosis: Old Infarction in MCA Territory
Case 12
Clinical Presentation
A 6 months old male child with history of neonatal neurological distress.
Radiological Findings
MR Scan sagittal (A) and axial (B,C) T1 and coronal T2-weighted images demonstrate a complete liquefaction of the cerebral hemispheres, which are replaced by large cysts of low-T1 and high-T2 signal intensity with thin septations and dilated ventricular system. Septae composed of glial cells and some viable neurons are seen as linear strands isointense to the brain tissue on both sequences. Note preservation of the cerebrum, which is considered as another typical findings.
Diagnosis: Diffuse Multicystic Encephalomalacia
Case 13
Clinical Presentation
A 9 year-old male child, presented with mental retardation and past-history of birth asphyxia.
Radiological Findings
MR Scan, axial T1 (A, B), FLAIR (C, D) and coronal T2 (E, F) weighted images showing a bilateral and symmetrical low-T1 and high-T2 and FLAIR signal-intensity of the lenticular and caudate nuclei. No other brain abnormality.
Diagnosis: Sequelae of Neonatal Anoxic/Ischemic Encephalopathy
Case 14
Clinical Presentation
A 72 year-old hypertensive female patient brought to the emergency department with left sided hemplegia and altered level of consciousness.
Radiological Findings
Nonenhanced brain CT Scan showing a large spontaneously hyperdense intraparenchymal lesion located in the right temporo-occipital region with surrounding hypodense edema, obliterating the adjacent ventricular horn with midline shift and sulcal effacement.
Diagnosis: Hemorrhagic Stroke
Case 15
Clinical Presentation
A 40 year-old male patient brought comatosed to the emergency department.
Radiological Findings
Plain brain CT Scan showing a large right frontal hematoma, surrounded by low-density area of edema with extensive intraventricular hemorrhage seen in the 4th, 3rd and lateral ventricles which are dilated with effacement of the cerebral sulci (due to cerebral edema) and midline shift to the left. There is a right fronto-temporal crescentic-shaped, homogeneous high-density collection of blood (subdural hematoma) due to a dissection of intraparenchymal hematoma into subarachnoid, then subdural space. No bone injury seen on the bone setting (not shown).
Diagnosis: Hemorrahgic CVA with Intra-ventricular Extension and SDH
Case 16
Clinical Presentation
A 25 year-old female with 10 days history of severe headache and diplopia.
Radiological Findings
Non-enhanced MR Scan sagittal T1 (A), coronal T2 (B), and axial FLAIR (C, D) images showing a hyperintense appearance in all sequences of the right lateral, straight and superior sagittal sinuses indicating cerebral venous sinuses thrombosis. No venous ischemic changes seen at both infra-or supra-tentorial level.
Diagnosis: Cerebral Venous Sinus Thrombosis (CVST)
Case 17
Clinical Presentation
A 23 year-old female patient with history of 6 months of headache without any neurological deficits.
Radiological Findings
Postcontrast CT axial (A) with coronal reconstruction (B) and MR Scan axial FLAIR (C) and postcontrast axial (D, E) and coronal T1 images: The enhanced CT Scan shows a densely enhancing linear structure in the right frontal lobe, coursing between the frontal horn of the right lateral ventricle and the inner table of skull. The MR sequences show a linear signal void structure on FLAIR image intensely enhanced after gadolinium administration with medusa-like branching (image E).
Diagnosis: Cerebral Venous Angioma
Case 18
Clinical Presentation
A 39 year-old female patient, complaining of chronic headaches.
Radiological Findings
Enhanced brain CT Scan showing an enlarged enhanced left cerebellar vessel, giving a caput medusa shape appearance, converging to a draining vein than into the left lateral venous sinus. No surrounding edema or mass effect.
Diagnosis: Venous Angioma
Case 19
Clinical Presentation
A 26 year-old female patient with history of chronic headaches and generalized epilepsy.
Radiological Findings
Pre-(A, B) and post-contrast (C, D) brain CT Scan showing a small left frontal hypodense lesion containing punctuate calcifications with significant enhancement after contrast administration. No surrounding edema or mass effect on the adjacent frontal horn.
Diagnosis: Cavernous Angioma
Case 20
Clinical Presentation
A 28 year-old female patient with history of generalized epilepsy.
Radiological Findings
MR Scan, axial FLAIR (A), coronal T2 (B), axial T*2-GE (C) and post-contrast axial T2 (D) images reveal a small quadriangular lesion of left frontal cortico-subcortical location. This lesion appears slightly hypointense on FLAIR and T2, hypointense on T2-GE with central hyperintensity with no surrounding edema and no enhancement after gadolinium administration.
Diagnosis: Cavernous Angioma
Case 21
Clinical Presentation
A 31 year-old male patient with recent epilepsy.
Radiological Findings
Brain MR, axial FLAIR (A, B, C), coronalT2 (D) and axialT*2-GE (E, F, G, H)-weighted images showing multiple lesions of cortical and sub-cortical location, one in the right cerebellum of heterogeneous signal centrally and hypointense peripherally, another similar lesion is seen in the right frontal lobe; the other lesions are mainly hypointense on T2-GE and located in the fronto=parietal regions.
Diagnosis: Multiple Cavernous Angiomas
Case 22
Clinical Presentation
A 72 year-old female patient known to have heart disease under sintron (acenocoumarol) tablets, presented with three days history of headaches, diplopia and convergent strabism.
Radiological Findings
MR Scan, pre-and post-contrast sagittal (A, B), coronal GE-T*2 (C), post-contrast axial T1 (D), axial FLAIR (E) and MRA 3D-TOF (F) showing a pre-pontic and retro-clival fusiform mass of complex signal intensity, extending from the dorsum sellae to the foramen magnum. On T1 this mass shows a sediment of high signal with no enhancement after gadolinium administration. The MRA did not reveal any abnormality of the basilar or vertebral arteries.
Diagnosis: Spontaneous Retroclival Hematoma (in patient under anti-coagulant)
Case 23
Clinical Presentation
An 8 year-old female child with long history of seizures.
Radiological Findings
Pre-(A , B, C) and post-contrast (D, E, F) brain CT Scan showing left para-and juxta-ventricular isodense serpiginous structures, containing linear calcification with intense and synchronous enhancement to the normal vascular structures, representing the nidus of an arterio-venous malformation. Note dilated draining cortical veins drained into the superior sagittal sinus.
...Continued, MR Scan, pre-contrast sagittalT1 (G), axial FLAIR (H), post-contrast axial (I), sagittal (J) and coronal (K) T1-weighted images with MRV-2D-TOF (L) demonstrate a tangle of serpiginous flow void structures with areas of high signal (slower flow), extending to the body of the corpus callosum and left lateral ventricle. The MRV shows the dilated draining cortical veins, drained into the superior sagittal sinus.
Diagnosis: Arterio-venous Malformation (AVM)
Case 24
Clinical Presentation
An 81 year-old female patient with history of chronic headaches, presented with right 3rd nerve palsy.
Radiological Findings
MR Scan, sagittal T1 (A), axial FLAIR (B), coronal T2 (C, D), Axial native 3D-TOF (E), post-contrast axial T1 (F, G) and MRA-3D-TOF (H) images showing a saccular structure filling the left cavernous sinus with supra-sellar extension with two components, the first component shows a signal void on T1, T2 and FLAIR with intense and synchronous enhancement to the left internal carotid artery; the second component is mainly of supra-sellar location, compressing certainly the right 3rd nerve and appears isointense onT1 and FLAIR and hypointense on T2 with no enhancement after contrast administration. On MRA-3D-TOF the right intra-cavernous and supra-clinoid portion of the internal carotid artery (ICA) shows reduced caliber, indicating partial thrombosis.
Diagnosis: Partially Thrombosed Aneurysm Of Intra-cavernous and Supra-clinoid ICA
Case 25
Clinical Presentation
A 40 year-old male patient, complaining of isolated headaches.
Radiological Findings
Enhanced brain CT Scan demonstrates a moderate fusiform dilatation of the basiar artery extending just above the vertebral arteries (as shown on image A). up to the 3rd ventricle level
... Continued, MR Scan, 3D-TOF native axial images (E, F), nonenhanced sagittal T1 (G, I), sagittal T2 (J) and MRA 3D-TOF (K) images show a moderately dilated basilar artery, partially thrombosed in its inferior portion as shown on the native 3D-TOF, sagittal T1 and T2 images. The MRA confirms the fusifom dilatation and partial thrombosis.
Diagnosis: Partially thrombosed Basilar Artery Aneurysm
Case 26
Clinical Presentation
A 5 months old female child with history of CHF and repeated tonico-clonic seizures.
Radiological Findings
MR Scan, sagittal T1 (A), axial FLAIR (B, C, D), coronal T2 (E, F), MRV-2D-TOF (G) and MRA-3D-TOF (H) images reveal a large flow-void demarcated vascular structure, posterior to the 3rd ventricle corresponding to a vein of Galen malformation with dilated draining venous system and trocular. The MRA shows the mural type of Galen varix with enlarged middle artery branches and multiple thalamoperforater feeders terminating in the varix. Note some cerebellar and cerebral atrophy mainly of the right hemisphere with right frontal and left occipital chronic subdural hematomas.
Diagnosis: Vein of Galen Aneurysm with Damaged Brain
Case 27
Clinical Presentation
A 71 year-old diabetic and hypertensive male patient with three weeks history of Mnesic disorder and lipothymia.
Radiological Findings
Pre-(A, B, C) and post-contrast (D, E, F, G, H) brain CT Scan: Note extensive evidence of dilated spontaneously hyperintense dilated venous structures, enhancing after contrast administration, visible around the brainstem and basal cisterns, drained into the straight sinus. The diffuse nature of enlarged deep and superficial venous system implies venous hypertension. Note dilated 3rd and lateral ventricles.
Diagnosis: Dural Arteriovenous Malformation (DAVM)
(Continues...)
Excerpted from Atlas Of Neuroradiology by Ammar HAOUIMI Copyright © 2012 by AMMAR HAOUIMI. Excerpted by permission of Trafford Publishing. All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.
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Table of Contents
Contents
-Vascular Diseases and Trauma: (Cases 1 to 34)....................1-Infection and Inflammatory Diseases: (Cases 35 to 44)....................41
-White Matter and Degenerative Diseases: (Cases 45 to 46)....................55
-Intra-and extra-axial Tumors: (Cases 47 to 104)....................59
-Malformations, Phacomatosis and Granulomatosis: (Cases 105 to 139)....................127
-Tumors of Spine: (Cases 140 to 152)....................171
-Infection and Inflammatory Diseases of Spine: (Cases 153 to 161)....................187
-Degenerative, and Trauma. of spine: (Cases 162 to 174)....................199
-Congenital anomalies of Spine and Spinal Cord: (Cases 175 to 198)....................215
-Miscellaneous: (Cases 199 to 200)....................243