Wilson's disease is a rare genetic disorder that causes copper to accumulate in the brain and other vital organs. MRI plays an important role in evaluating patients with suspected Wilson's disease. Key findings on MRI include signal changes in the basal ganglia, midbrain, pons, and cerebral white matter. Characteristic signs include T1 hyperintensity of the globus pallidus, the "face of the giant panda" sign, and CPM-like changes resembling osmotic demyelination. Serial MRI can show improvement in many patients responding to treatment, while extensive changes correlate with poorer prognosis. Advanced techniques like DTI reveal more widespread white matter abnormalities than conventional MRI and help assess disease severity.
This document discusses Doppler ultrasound of the kidneys. It begins with the normal anatomy of the kidneys and renal vasculature. It then describes how to perform grayscale and Doppler ultrasound of the kidneys, including imaging planes and settings. Normal Doppler waveforms of renal arteries are presented. Key measurements like resistive index, acceleration time, and peak systolic velocity of renal arteries are discussed. Variants of renal and renal vein anatomy are also reviewed.
This document discusses Cauda Equina Syndrome, a medical condition where the bundle of nerves (cauda equina) in the lower back is compressed, putting pressure on the nerves that control bowel and bladder function. It provides details on a patient case, symptoms like pain, saddle anesthesia, and bladder/bowel dysfunction. Research findings are presented on outcomes depending on surgery timing (better outcomes for patients treated within 48 hours) and severity of bladder/bowel dysfunction. Categories of cauda equina syndrome severity and their relationship to surgery outcomes are described from a 2016 literature review.
Imaging based selection of patients for acute stroke treatmentSachin Adukia
1) Several positive randomized controlled trials from 2015 established endovascular therapy (EVT) as effective for recanalization in patients with acute proximal anterior circulation artery occlusion.
2) Non-invasive neuroimaging is needed to exclude intracranial hemorrhage, confirm and localize treatable vessel occlusions, detect irreversible ischemic damage, and characterize salvageable tissue.
3) Recent studies have demonstrated that imaging-based selection of patients for EVT, including analysis of infarct core size, penumbra, and collateral flow, can effectively identify patients likely to benefit from the procedure beyond the 6 hour time window established in earlier trials.
Bone age estimation is important for monitoring growth, puberty, and predicting adult height. The hand wrist radiograph is commonly used, with the Greulich and Pyle (G-P) atlas and Tanner and Whitehouse methods assessing ossification centers. G-P matches radiographs to standard images while Tanner assigns scores to 20 bones. Other sites like the pelvis, elbow and knee can also indicate skeletal maturity through fusion of centers.
This document contains descriptions and images of various filling defects that can occur in the colon as seen on medical imaging. Some of the defects described and shown include colonic polyps, colon cancer, lipomas, lymphomas, familial polyposis, inflammatory pseudopolyposis, fecal impaction, endometriosis, intussusception, hemorrhoids, nodular lymphoid hyperplasia, and colonic urticaria. The document serves as an atlas to aid differential diagnosis of filling defects seen on colon imaging.
The document discusses diagnostic radiology of musculoskeletal system fractures and tumor-like lesions. It begins by defining fractures and describing their classification, location, alignment, healing process and complications. It then discusses specific fracture types like Colles fractures, supracondylar fractures, compression fractures and burst fractures. Finally, it covers tumor-like lesions such as osteosarcoma, describing their presentation, location and radiographic findings.
Ultrasound of the urinary tract - Renal infectionsSamir Haffar
Ultrasound can detect various renal infections including:
1) Acute pyelonephritis seen as renal enlargement, decreased echogenicity, and loss of corticomedullary differentiation on ultrasound.
2) Renal abscesses appear as hypoechoic masses with thick irregular walls that increase in distinctness over time.
3) Pyohydronephrosis is infection of the obstructed collecting system seen as echogenic debris and fluid-fluid levels.
4) Emphysematous pyelonephritis involves gas in the renal parenchyma seen as high amplitude echoes and dirty shadowing.
This document discusses Doppler ultrasound of the kidneys. It begins with the normal anatomy of the kidneys and renal vasculature. It then describes how to perform grayscale and Doppler ultrasound of the kidneys, including imaging planes and settings. Normal Doppler waveforms of renal arteries are presented. Key measurements like resistive index, acceleration time, and peak systolic velocity of renal arteries are discussed. Variants of renal and renal vein anatomy are also reviewed.
This document discusses Cauda Equina Syndrome, a medical condition where the bundle of nerves (cauda equina) in the lower back is compressed, putting pressure on the nerves that control bowel and bladder function. It provides details on a patient case, symptoms like pain, saddle anesthesia, and bladder/bowel dysfunction. Research findings are presented on outcomes depending on surgery timing (better outcomes for patients treated within 48 hours) and severity of bladder/bowel dysfunction. Categories of cauda equina syndrome severity and their relationship to surgery outcomes are described from a 2016 literature review.
Imaging based selection of patients for acute stroke treatmentSachin Adukia
1) Several positive randomized controlled trials from 2015 established endovascular therapy (EVT) as effective for recanalization in patients with acute proximal anterior circulation artery occlusion.
2) Non-invasive neuroimaging is needed to exclude intracranial hemorrhage, confirm and localize treatable vessel occlusions, detect irreversible ischemic damage, and characterize salvageable tissue.
3) Recent studies have demonstrated that imaging-based selection of patients for EVT, including analysis of infarct core size, penumbra, and collateral flow, can effectively identify patients likely to benefit from the procedure beyond the 6 hour time window established in earlier trials.
Bone age estimation is important for monitoring growth, puberty, and predicting adult height. The hand wrist radiograph is commonly used, with the Greulich and Pyle (G-P) atlas and Tanner and Whitehouse methods assessing ossification centers. G-P matches radiographs to standard images while Tanner assigns scores to 20 bones. Other sites like the pelvis, elbow and knee can also indicate skeletal maturity through fusion of centers.
This document contains descriptions and images of various filling defects that can occur in the colon as seen on medical imaging. Some of the defects described and shown include colonic polyps, colon cancer, lipomas, lymphomas, familial polyposis, inflammatory pseudopolyposis, fecal impaction, endometriosis, intussusception, hemorrhoids, nodular lymphoid hyperplasia, and colonic urticaria. The document serves as an atlas to aid differential diagnosis of filling defects seen on colon imaging.
The document discusses diagnostic radiology of musculoskeletal system fractures and tumor-like lesions. It begins by defining fractures and describing their classification, location, alignment, healing process and complications. It then discusses specific fracture types like Colles fractures, supracondylar fractures, compression fractures and burst fractures. Finally, it covers tumor-like lesions such as osteosarcoma, describing their presentation, location and radiographic findings.
Ultrasound of the urinary tract - Renal infectionsSamir Haffar
Ultrasound can detect various renal infections including:
1) Acute pyelonephritis seen as renal enlargement, decreased echogenicity, and loss of corticomedullary differentiation on ultrasound.
2) Renal abscesses appear as hypoechoic masses with thick irregular walls that increase in distinctness over time.
3) Pyohydronephrosis is infection of the obstructed collecting system seen as echogenic debris and fluid-fluid levels.
4) Emphysematous pyelonephritis involves gas in the renal parenchyma seen as high amplitude echoes and dirty shadowing.
CHRONIC KIDNEY DISEASE- A CASE STUDY IN AYURVEDIC SETTING.VIKAS NARIYAAL
Chronic kidney diseases CKD encompasses a spectrum of different pathophysiologic proCesses associated with abnormal kidney function and a progressive decline in glomerular filtration rate (GFR)
Rickets is a childhood bone disease caused by vitamin D deficiency and impaired bone mineralization. Symptoms include bone pain, soft tissue swelling, and bone deformities. Radiographically, rickets is characterized by widened growth plates with irregular and frayed metaphyseal margins, cupping of the metaphysis, and generalized osteopenia. Specific findings include craniotabes, bowing deformities of the long bones, rib fractures causing a "rachitic rosary" appearance, and triradiate pelvis. The document provides detailed radiological descriptions and images of findings in rickets.
This document provides descriptions of various radiological signs seen on abdominal imaging and their associated clinical conditions. It lists over 20 different radiological signs in alphabetical order, including the apple core sign seen with colonic carcinoma, bird's beak sign seen with achalasia, bowler hat sign seen with colonic diverticulum, and double bubble sign seen with duodenal atresia. For each sign, a brief 1-2 sentence description of the imaging appearance and associated clinical condition is given. The document serves as a reference for interpreting common radiological findings on abdominal x-rays and contrast studies.
The Epidemic of Thyroid Nodules: Which Should Undergo Fine Needle Aspiration?u.surgery
The document discusses thyroid nodules and guidelines for performing fine needle aspiration (FNA). It notes that while thyroid nodules are common, detected in up to 67% of ultrasound exams, only 5-15% of nodules are malignant. Sonographic features that increase the likelihood of malignancy include microcalcifications, irregular margins, hypoechogenicity, and intranodular flow. The document recommends FNA for nodules over 1 cm in size or if sonographic features suggest cancer risk. Strategic FNA based on risk factors aims to identify the minority of nodules that are cancer while avoiding unnecessary biopsies of predominantly benign nodules.
Ultrasound of acute & chronic cholecystitisSamir Haffar
This document discusses ultrasound findings related to cholecystitis. It describes the ultrasound appearance of acute cholecystitis, including signs like gallbladder wall thickening, pericholecystic fluid, and hyperemia on Doppler. Complications of acute cholecystitis are also reviewed, such as emphysematous cholecystitis where gas is visible in the gallbladder wall. Chronic cholecystitis is also summarized, noting findings like gallstones, wall thickening, and occasionally calcification or nodules indicative of xanthogranulomatous cholecystitis.
1) Paget's disease is a chronic bone disorder characterized by excessive abnormal bone remodeling that commonly affects older adults, with prevalence increasing from 4% in those over 40 to 11% over 80.
2) It typically involves multiple bones (polyostotic) and bones asymmetrically. Common sites are the pelvis, spine, skull, and proximal long bones.
3) Radiographically, Paget's disease presents with thickened bone cortex, accentuated trabecular pattern, and enlarged bone size ("classic triad"). In the pelvis, thickening occurs along the iliopubic and ilioschial lines. In the spine, vertebrae have a "picture frame"
- Places fingers over the lower ribs on the left side
- Asks patient to take a deep breath
You:
- Percuss over the assistant's fingers
- Dullness indicates splenic enlargement crossing
the midline
Positive Nixon's sign suggests splenomegaly.
This document discusses lumbosacral transitional vertebrae (LSTV), which are congenital spinal anomalies involving sacralization of the lowest lumbar segment or lumbarization of the highest sacral segment. LSTVs can be classified based on imaging features and involve fusion of the transverse process to the sacrum. Numbering the vertebrae can be challenging with LSTVs. Prediction of LSTVs on MRI is possible based on increased A and B angles on sagittal images, which measure the inclination of the sacrum and lumbar lordosis. LSTVs can cause low back pain known as Bertolotti syndrome through various mechanisms.
This document provides an overview of the classification and assessment of skeletal abnormalities. It discusses the main categories of skeletal dysplasias including osteochondrodysplasias, dysostoses, and other disorders. Prenatal ultrasound assessment of skeletal abnormalities is outlined examining features of the skull, chest, spine, and long bones. Postnatal assessment involves examining disproportion, limb involvement, spine, chest, and skeletal radiography. Key anatomical locations and bone abnormalities are described.
Squeezed through holes: imaging of internal herniaAhmed Bahnassy
This document discusses internal hernias, which occur when abdominal organs protrude through openings within the abdominal cavity. It describes several types of internal hernias, including paraduodenal, foramen of Winslow, intersigmoid, pericecal, transmesenteric, and retroanastomotic hernias. For each type, it provides details on location, risk factors, and radiographic findings such as clustering of bowel loops and abnormalities of mesenteric vessels. The document emphasizes the importance of recognizing abnormal bowel positioning and configurations, signs of obstruction, and vessel abnormalities on imaging studies to diagnose internal hernias.
Imaging in neurology - normal MR Angio and VenographyNeurologyKota
There are two main types of MR angiography (MRA): contrast-enhanced (CE) MRA and non-contrast enhanced MRA, which includes time-of-flight (TOF) MRA and phase contrast (PC) MRA. CE MRA uses an injected gadolinium contrast agent and is faster than non-contrast MRA. TOF MRA detects blood flow without contrast but is susceptible to artifacts. PC MRA measures blood velocity and flow direction and can quantify blood flow. MR venography (MRV) uses similar techniques as MRA to image veins and is useful for detecting cerebral venous thrombosis. Common applications of MRA and MRV include evaluation of aneurysms, neck vessels, and cerebral
Wilson's disease is an inherited disorder that causes copper to accumulate in the liver and other organs. This document discusses the pathophysiology, clinical manifestations, diagnosis, and treatment of Wilson's disease. It provides guidelines from the European Association for the Study of the Liver and the American Association for the Study of Liver Diseases. Key points include that Wilson's disease should be considered for any unexplained liver or neurological conditions, a low ceruloplasmin level supports the diagnosis, treatment is lifelong chelation therapy or zinc, and liver transplantation may be needed for decompensated cirrhosis.
This document provides a differential diagnosis for bilateral abnormalities seen on imaging of the basal ganglia and thalamus. It reviews the anatomy of these structures and then describes various pathologies that can cause bilateral involvement, including toxic poisoning, liver disease, hypoglycemia, hypoxic ischemic encephalopathy, Leigh disease, Wilson disease, osmotic myelinolysis, and others. For each pathology, the causes, clinical features, and imaging findings such as location and appearance on MRI are summarized.
This document describes various findings that may be seen on an abdominal x-ray, including signs of small bowel obstruction, duodenal atresia, large bowel obstruction, sigmoid volvulus, colon cancer, colon fibrosis, calcified vas deferens, bladder calculi, renal calculi, staghorn calcification, nephrocalcinosis, and calcified gallstones. It provides radiologists and physicians with key things to look for on an abdominal x-ray and what different findings may indicate.
This document contains multiple patient case summaries and medical images/reports with questions related to diagnosis and management. Some key cases include:
- A 55-year-old male presenting with shortness of breath, whose chest X-ray shows cardiomegaly and upper lobe diversion.
- A 35-year-old male with progressive shortness of breath and cough presenting with bilateral hilar lymphadenopathy on chest X-ray, leading to a diagnosis of sarcoidosis.
- An ECG showing findings of atrial fibrillation in a 35-year-old female presenting with palpitations.
- A CT scan of a 30-year-old IV drug user presenting with fever
WHY IS THIS topic important
It is because prostate cancer is very common and but a good proportion of these cancers are considered clinically insignificant
And then there are more aggressive ones which are clinically significant which need to be treated
Our goal is to improve detection of these before they spread So that they can be treated
Bone scintigraphy uses radiolabeled phosphonates injected intravenously to evaluate bone formation. It produces whole body images of tracer distribution in the skeleton. Increased uptake indicates elevated osteoblastic activity such as might occur with fractures, tumors, or metastases. The scan has high sensitivity but low specificity for bone abnormalities, so findings must be interpreted in clinical context. It is useful for detecting skeletal involvement by cancer or other bone diseases.
This document discusses Doppler ultrasound of the kidneys. It begins by describing the normal anatomy of the kidneys and renal vasculature. It then discusses how to perform grayscale and Doppler ultrasound exams of the kidneys, including identifying normal anatomical variants. Technical parameters for optimizing Doppler signals are provided. Normal Doppler waveform indices for the renal arteries are defined, including peak systolic velocity, resistive index, acceleration time and acceleration index.
Interpretation of musculoskeletal x raysjatinder12345
This document provides an overview of interpreting musculoskeletal x-rays, including key things to look for when examining x-rays of different bones and joints. It emphasizes examining two views of each joint, comparing views to previous x-rays, and looking for abnormalities in bone structure, joints, and soft tissues that could indicate fractures, structural anomalies, or degenerative conditions. The document then provides examples of normal and abnormal x-ray findings for many bones and joints throughout the body.
Neuroradiology in multiple sclerosis
MRI in diagnosis of MS
MRI in D.D. of MS
MRI in monitoring disease progression and response to DMT
New imaging techniques
This study investigated the use of susceptibility vessel sign (SVS) on susceptibility weighted imaging (SWI) MRI to detect thrombus in patients with acute ischemic stroke. The study found that SVS was present in 62.8% of patients with confirmed vessel occlusion on MR angiography. SVS detection was correlated with risk factors like cardiac disease and territories of occlusion like the MCA. A moderate correlation was also found between thrombus length seen with SVS and NIH stroke scale scores. However, the study was limited by its small sample size and retrospective design. In conclusion, SVS on SWI can help identify thrombus location and burden in acute stroke.
CHRONIC KIDNEY DISEASE- A CASE STUDY IN AYURVEDIC SETTING.VIKAS NARIYAAL
Chronic kidney diseases CKD encompasses a spectrum of different pathophysiologic proCesses associated with abnormal kidney function and a progressive decline in glomerular filtration rate (GFR)
Rickets is a childhood bone disease caused by vitamin D deficiency and impaired bone mineralization. Symptoms include bone pain, soft tissue swelling, and bone deformities. Radiographically, rickets is characterized by widened growth plates with irregular and frayed metaphyseal margins, cupping of the metaphysis, and generalized osteopenia. Specific findings include craniotabes, bowing deformities of the long bones, rib fractures causing a "rachitic rosary" appearance, and triradiate pelvis. The document provides detailed radiological descriptions and images of findings in rickets.
This document provides descriptions of various radiological signs seen on abdominal imaging and their associated clinical conditions. It lists over 20 different radiological signs in alphabetical order, including the apple core sign seen with colonic carcinoma, bird's beak sign seen with achalasia, bowler hat sign seen with colonic diverticulum, and double bubble sign seen with duodenal atresia. For each sign, a brief 1-2 sentence description of the imaging appearance and associated clinical condition is given. The document serves as a reference for interpreting common radiological findings on abdominal x-rays and contrast studies.
The Epidemic of Thyroid Nodules: Which Should Undergo Fine Needle Aspiration?u.surgery
The document discusses thyroid nodules and guidelines for performing fine needle aspiration (FNA). It notes that while thyroid nodules are common, detected in up to 67% of ultrasound exams, only 5-15% of nodules are malignant. Sonographic features that increase the likelihood of malignancy include microcalcifications, irregular margins, hypoechogenicity, and intranodular flow. The document recommends FNA for nodules over 1 cm in size or if sonographic features suggest cancer risk. Strategic FNA based on risk factors aims to identify the minority of nodules that are cancer while avoiding unnecessary biopsies of predominantly benign nodules.
Ultrasound of acute & chronic cholecystitisSamir Haffar
This document discusses ultrasound findings related to cholecystitis. It describes the ultrasound appearance of acute cholecystitis, including signs like gallbladder wall thickening, pericholecystic fluid, and hyperemia on Doppler. Complications of acute cholecystitis are also reviewed, such as emphysematous cholecystitis where gas is visible in the gallbladder wall. Chronic cholecystitis is also summarized, noting findings like gallstones, wall thickening, and occasionally calcification or nodules indicative of xanthogranulomatous cholecystitis.
1) Paget's disease is a chronic bone disorder characterized by excessive abnormal bone remodeling that commonly affects older adults, with prevalence increasing from 4% in those over 40 to 11% over 80.
2) It typically involves multiple bones (polyostotic) and bones asymmetrically. Common sites are the pelvis, spine, skull, and proximal long bones.
3) Radiographically, Paget's disease presents with thickened bone cortex, accentuated trabecular pattern, and enlarged bone size ("classic triad"). In the pelvis, thickening occurs along the iliopubic and ilioschial lines. In the spine, vertebrae have a "picture frame"
- Places fingers over the lower ribs on the left side
- Asks patient to take a deep breath
You:
- Percuss over the assistant's fingers
- Dullness indicates splenic enlargement crossing
the midline
Positive Nixon's sign suggests splenomegaly.
This document discusses lumbosacral transitional vertebrae (LSTV), which are congenital spinal anomalies involving sacralization of the lowest lumbar segment or lumbarization of the highest sacral segment. LSTVs can be classified based on imaging features and involve fusion of the transverse process to the sacrum. Numbering the vertebrae can be challenging with LSTVs. Prediction of LSTVs on MRI is possible based on increased A and B angles on sagittal images, which measure the inclination of the sacrum and lumbar lordosis. LSTVs can cause low back pain known as Bertolotti syndrome through various mechanisms.
This document provides an overview of the classification and assessment of skeletal abnormalities. It discusses the main categories of skeletal dysplasias including osteochondrodysplasias, dysostoses, and other disorders. Prenatal ultrasound assessment of skeletal abnormalities is outlined examining features of the skull, chest, spine, and long bones. Postnatal assessment involves examining disproportion, limb involvement, spine, chest, and skeletal radiography. Key anatomical locations and bone abnormalities are described.
Squeezed through holes: imaging of internal herniaAhmed Bahnassy
This document discusses internal hernias, which occur when abdominal organs protrude through openings within the abdominal cavity. It describes several types of internal hernias, including paraduodenal, foramen of Winslow, intersigmoid, pericecal, transmesenteric, and retroanastomotic hernias. For each type, it provides details on location, risk factors, and radiographic findings such as clustering of bowel loops and abnormalities of mesenteric vessels. The document emphasizes the importance of recognizing abnormal bowel positioning and configurations, signs of obstruction, and vessel abnormalities on imaging studies to diagnose internal hernias.
Imaging in neurology - normal MR Angio and VenographyNeurologyKota
There are two main types of MR angiography (MRA): contrast-enhanced (CE) MRA and non-contrast enhanced MRA, which includes time-of-flight (TOF) MRA and phase contrast (PC) MRA. CE MRA uses an injected gadolinium contrast agent and is faster than non-contrast MRA. TOF MRA detects blood flow without contrast but is susceptible to artifacts. PC MRA measures blood velocity and flow direction and can quantify blood flow. MR venography (MRV) uses similar techniques as MRA to image veins and is useful for detecting cerebral venous thrombosis. Common applications of MRA and MRV include evaluation of aneurysms, neck vessels, and cerebral
Wilson's disease is an inherited disorder that causes copper to accumulate in the liver and other organs. This document discusses the pathophysiology, clinical manifestations, diagnosis, and treatment of Wilson's disease. It provides guidelines from the European Association for the Study of the Liver and the American Association for the Study of Liver Diseases. Key points include that Wilson's disease should be considered for any unexplained liver or neurological conditions, a low ceruloplasmin level supports the diagnosis, treatment is lifelong chelation therapy or zinc, and liver transplantation may be needed for decompensated cirrhosis.
This document provides a differential diagnosis for bilateral abnormalities seen on imaging of the basal ganglia and thalamus. It reviews the anatomy of these structures and then describes various pathologies that can cause bilateral involvement, including toxic poisoning, liver disease, hypoglycemia, hypoxic ischemic encephalopathy, Leigh disease, Wilson disease, osmotic myelinolysis, and others. For each pathology, the causes, clinical features, and imaging findings such as location and appearance on MRI are summarized.
This document describes various findings that may be seen on an abdominal x-ray, including signs of small bowel obstruction, duodenal atresia, large bowel obstruction, sigmoid volvulus, colon cancer, colon fibrosis, calcified vas deferens, bladder calculi, renal calculi, staghorn calcification, nephrocalcinosis, and calcified gallstones. It provides radiologists and physicians with key things to look for on an abdominal x-ray and what different findings may indicate.
This document contains multiple patient case summaries and medical images/reports with questions related to diagnosis and management. Some key cases include:
- A 55-year-old male presenting with shortness of breath, whose chest X-ray shows cardiomegaly and upper lobe diversion.
- A 35-year-old male with progressive shortness of breath and cough presenting with bilateral hilar lymphadenopathy on chest X-ray, leading to a diagnosis of sarcoidosis.
- An ECG showing findings of atrial fibrillation in a 35-year-old female presenting with palpitations.
- A CT scan of a 30-year-old IV drug user presenting with fever
WHY IS THIS topic important
It is because prostate cancer is very common and but a good proportion of these cancers are considered clinically insignificant
And then there are more aggressive ones which are clinically significant which need to be treated
Our goal is to improve detection of these before they spread So that they can be treated
Bone scintigraphy uses radiolabeled phosphonates injected intravenously to evaluate bone formation. It produces whole body images of tracer distribution in the skeleton. Increased uptake indicates elevated osteoblastic activity such as might occur with fractures, tumors, or metastases. The scan has high sensitivity but low specificity for bone abnormalities, so findings must be interpreted in clinical context. It is useful for detecting skeletal involvement by cancer or other bone diseases.
This document discusses Doppler ultrasound of the kidneys. It begins by describing the normal anatomy of the kidneys and renal vasculature. It then discusses how to perform grayscale and Doppler ultrasound exams of the kidneys, including identifying normal anatomical variants. Technical parameters for optimizing Doppler signals are provided. Normal Doppler waveform indices for the renal arteries are defined, including peak systolic velocity, resistive index, acceleration time and acceleration index.
Interpretation of musculoskeletal x raysjatinder12345
This document provides an overview of interpreting musculoskeletal x-rays, including key things to look for when examining x-rays of different bones and joints. It emphasizes examining two views of each joint, comparing views to previous x-rays, and looking for abnormalities in bone structure, joints, and soft tissues that could indicate fractures, structural anomalies, or degenerative conditions. The document then provides examples of normal and abnormal x-ray findings for many bones and joints throughout the body.
Neuroradiology in multiple sclerosis
MRI in diagnosis of MS
MRI in D.D. of MS
MRI in monitoring disease progression and response to DMT
New imaging techniques
This study investigated the use of susceptibility vessel sign (SVS) on susceptibility weighted imaging (SWI) MRI to detect thrombus in patients with acute ischemic stroke. The study found that SVS was present in 62.8% of patients with confirmed vessel occlusion on MR angiography. SVS detection was correlated with risk factors like cardiac disease and territories of occlusion like the MCA. A moderate correlation was also found between thrombus length seen with SVS and NIH stroke scale scores. However, the study was limited by its small sample size and retrospective design. In conclusion, SVS on SWI can help identify thrombus location and burden in acute stroke.
Rheumatological aspects in hemodialysis patients 2019Samar Tharwat
This document summarizes rheumatological aspects of musculoskeletal disorders in hemodialysis patients. It discusses disorders related to dialysis such as dialysis-related amyloidosis, as well as non-crystalline disorders like tendonitis and uremic myopathy. Crystalline disorders covered include gout, pseudogout, and disorders associated with calcium crystals. Specific clinical manifestations are described for many of these conditions. Treatment focuses on optimizing dialysis and medication management. Musculoskeletal ultrasound is highlighted as a useful diagnostic tool. The conclusion discusses a study assessing quality of life and musculoskeletal discomfort in Egyptian hemodialysis patients using validated questionnaires.
Dr Trevor Pickersgill - Diagnosing a RelapseMS Trust
1) Diagnosing relapses in multiple sclerosis (MS) patients can be complex, as relapses can mimic other conditions and symptoms are not always clearly MS-related.
2) It is important to properly diagnose relapses to determine the MS disease course, guide treatment decisions, and understand the patient's prognosis.
3) In addition to traditional relapses, atypical presentations must be considered, such as relapses related to MS treatments, infections, neurological conditions mimicking MS, and non-neurological or functional issues. A thorough examination is needed.
Vertebral osteomyelitis( spondylodiskitis )
usually seen in adults (median age is 50 to 60 years)
Location
50-60% of cases occur in lumbar spine
30-40% in thoracic spine
~10% in cervical spine
The study investigated the relationship between dilated Virchow-Robin spaces (VRS) seen on MRI and cerebral microvascular disease in elderly patients with dementia. 75 patients with Alzheimer's disease, ischemic vascular dementia, or frontotemporal dementia underwent MRI and were compared to 35 healthy volunteers. VRS scores were significantly higher in patients with vascular dementia compared to those with Alzheimer's disease, frontotemporal dementia, or healthy volunteers. VRS scores accounted for 29% of the variance in a regression model, more than periventricular hyperintensities, suggesting dilated VRS are a sensitive indicator of cerebral microvascular disease.
This document presents a case study of a 68-year-old female patient who presented to the emergency department with worsening lower back pain, lower limb weakness, loss of sensation, urinary retention, and fever. Imaging revealed an extensive precontrast T1 hyperintense thoracolumbar spinal canal extramedullary collection consistent with a spinal epidural abscess. The patient was treated with hemodialysis, IV antibiotics, and a neurosurgery consultation was obtained. The document reviews spinal epidural abscesses, including risk factors, pathogenesis, diagnosis, differential diagnosis, management, and key points.
This document presents a case study of a 68-year-old female patient who presented to the emergency department with worsening lower back pain, lower limb weakness, loss of sensation, urinary retention, and fever. Imaging revealed an extensive precontrast T1 hyperintense thoracolumbar spinal canal extramedullary collection consistent with a spinal epidural abscess. The patient was treated with hemodialysis, IV antibiotics, and a neurosurgery consultation was obtained. The document reviews spinal epidural abscesses, including risk factors, pathogenesis, diagnosis, differential diagnosis, management, and key points.
The document discusses a study of 11 patients with surgically confirmed degenerative dorsal disc herniation. Clinical exams and tests found higher rates of vascular risk factors and increased blood viscosity in these patients compared to controls. MRI and CT myelography showed partially or heavily calcified disc herniations in the lower dorsal spine. The clinical presentation was characterized by a mainly motor myelopathy with remissions and exacerbations. The findings help explain the pathogenesis and clinical presentation of myelopathy from degenerative dorsal disc disease.
the presentation gives a detail information about the seronegative spondyloarthropathy. this ppt also provide recent evidences to frame the rehab protocol.
Wilson's disease is a rare genetic disorder caused by mutations in the ATP7B gene. It typically presents in the second or third decade with neurological symptoms like tremors or dystonia, and liver problems. Diagnosis involves low copper levels, elevated liver enzymes, urine or genetic tests. Treatment aims to remove excess copper with chelating agents or zinc, while monitoring for complications long-term.
Wilson Disease - Beyond the liver and brain…- Dr Ujjal PoddarSanjeev Kumar
This document discusses the non-hepatic and non-neurological manifestations of Wilson's disease. It summarizes several studies that found the majority of Wilson's disease patients presented with hepatic or neurological symptoms, while a minority exhibited other manifestations. These included bone, joint, eye, heart, blood, kidney, skin and endocrine issues. Specifically, it notes that bone and joint pain can be early presenting symptoms and unexplained hemolysis in young adults should raise suspicion for Wilson's disease screening. The document concludes that while uncommon, recognition of non-hepatic manifestations is important for fully characterizing and managing Wilson's disease.
Cervical radiculopathy is pain in an arm caused by compression of a cervical nerve root. It is commonly caused by cervical spondylosis which results in decreased disc height and bone spurs around the vertebrae that can compress nerve roots. Physical exam findings may include pain and sensory changes in the arm corresponding to the affected nerve root level as well as weakness or reflex changes. Diagnosis is based on history, physical exam, and imaging such as MRI which is the most sensitive test for evaluating soft tissues like discs and nerves. Most cases improve over time but surgery may be needed if conservative treatment fails.
This document summarizes a neurosciences academic meeting that discussed a case of a 25-year-old female who presented with sudden onset of her worst headache ever. Differential diagnoses for thunderclap headache were discussed. Imaging revealed a subarachnoid hemorrhage from an aneurysm. The meeting discussed CT and MR angiography as diagnostic tools compared to catheter angiography, and yields of CSF analysis for diagnosing aneurysmal subarachnoid hemorrhage. Causes of subarachnoid hemorrhage without an identified aneurysm were also reviewed, as well as a new clinical decision tool to exclude subarachnoid hemorrhage.
Spinal Tuberculosis by Dr. Monsif IqbalMonsif Iqbal
This document presents a case of spinal tuberculosis. It describes a 45-year-old female patient who presented with severe back pain of one week duration. Examination found tenderness in the lumbar spine and limited straight leg raise. Imaging including x-ray and MRI confirmed the diagnosis of spinal tuberculosis affecting L1 and L2. The document then provides details on the pathogenesis, clinical presentation, diagnosis, imaging features, complications and management of spinal tuberculosis.
The document discusses spinal involvement in crystal-related diseases, focusing on gout. Spine involvement in gout is uncommon but can occur in cases of severe tophaceous gout. Symptoms may be asymptomatic initially or include acute or chronic back pain and nerve compression. Diagnosis is made through identification of urate crystals via aspiration or biopsy of spinal lesions. Imaging such as CT, MRI can show erosions, tophi, and lesions affecting various spinal structures including intervertebral discs, facet joints, and ligaments. Spinal cord or cauda equina compression may occur due to large tophi. While back pain is present in about half of cases, spinal involvement in gout is often missed likely due to
1) The patient presented with sudden loss of consciousness and was diagnosed with subarachnoid hemorrhage complicated by acute pulmonary embolism based on imaging and clinical findings.
2) Subarachnoid hemorrhage is bleeding in the subarachnoid space caused most commonly by ruptured aneurysms. It can cause severe headaches and has high mortality.
3) Complications of subarachnoid hemorrhage include rebleeding, hydrocephalus, and pulmonary embolism which the patient presented with and was treated for.
This case report describes a 76-year-old male patient diagnosed with Marine-Lenhart syndrome. The patient had a history of Graves' disease treated with antithyroid drugs. Tests showed suppressed TSH levels and the patient was referred to an endocrinology department. Exams including ultrasound and scintigraphy revealed the patient had Graves' disease along with a hyperactive nodule in the thyroid, consistent with Marine-Lenhart syndrome. The patient was treated with antithyroid drugs followed by radioactive iodine therapy. Follow up showed improvement of hyperthyroidism symptoms. Marine-Lenhart syndrome is a rare cause of hyperthyroidism where a patient has Graves' disease concurrently with a hyperfunctional thyroid nodule.
This document summarizes research on chronic cerebrospinal venous insufficiency (CCSVI) and its proposed link to multiple sclerosis (MS). Several studies found no association between CCSVI and MS, including a large blinded case-control study. The validity of ultrasound criteria for CCSVI was also challenged. While initial studies reported benefits from angioplasty to treat CCSVI, later work revealed major flaws and no evidence was found to support CCSVI playing a causal role in MS or to justify further research on the proposed "liberation treatment."
Neurosarcoidosis is a rare condition where sarcoidosis affects the nervous system. It can be difficult to diagnose as it often presents with non-specific neurological symptoms. Diagnosis requires a combination of CSF analysis, MRI imaging showing characteristic abnormalities, and biopsy evidence of granulomas. A multidisciplinary team approach is needed to manage this complex condition.
Similar to Role of MRI in Wilson disease - Dr Sanjib Sinha (20)
1. An 8-year-old male presented with resistant rickets and bony deformities. Initial workup found hypocalcemia, hypophosphatemia, elevated alkaline phosphatase, and normal parathyroid hormone.
2. Further testing revealed proximal renal tubular acidosis, hypokalemia, and firm hepatomegaly. Wilson's disease was suspected and confirmed with elevated urinary copper levels.
3. The patient was diagnosed with Wilson's disease presenting as resistant rickets and proximal renal tubular acidosis. He was started on chelating agents and potassium citrate to treat the Wilson's disease and renal tubular acidosis respectively.
This document discusses the role of liver biopsy in determining the stage and cause of liver disease. A liver biopsy can reveal the stage of disease, whether it is caused by autoimmune, metabolic, or viral factors. Early stage disease may show minor changes like mild steatosis, while later stages show features like portal inflammation, interface hepatitis, steatosis, glycogenated nuclei, Mallory bodies, and copper accumulation. Copper stains on biopsy tissue can help determine if Wilson's disease is present, shown by red-orange or black-brown copper deposits. The document also describes several case examples where liver biopsy aided in diagnosis, such as diagnosing Wilson's disease in an 8-year old male based on cirrhosis and
Key publications on wilson disease in last 3 yearsSanjeev Kumar
This document summarizes key publications on Wilson disease from the last 3 years. It discusses clinical profiles of Wilson disease patients, patient and graft survival rates post-liver transplantation, issues with immunosuppressive regimens post-transplant, and experimental adenoviral gene therapy providing long-term correction of copper metabolism in a mouse model of Wilson disease. It also presents studies finding that increased levels of non-ceruloplasmin bound and exchangeable copper are associated with oxidative stress and neurological worsening in Wilson disease patients.
This document summarizes a case discussion of a 10-year-old female patient presenting with acute liver failure and hemolysis who was potentially in need of a liver transplant. The patient had symptoms for 4 weeks and was initially evaluated at a nearby hospital before being referred for further evaluation. On examination, she had pallor, icterus, periorbital puffiness, distended abdomen, and enlarged liver and spleen. Investigations showed abnormal liver function tests and signs of hemolysis. Based on further testing, she was diagnosed with Wilson's disease. Due to developing grade 2 encephalopathy, she underwent living-related liver transplantation with her mother as the donor. She recovered well after the transplant.
When does one use zinc alone - Dr Vinay GoyalSanjeev Kumar
This document discusses the use of zinc alone in treating Wilson's disease. Zinc is the preferred initial treatment as it is nontoxic and prevents copper absorption in the intestine. It works by inducing intestinal metallothionein and blocking copper absorption and resorption from the gastrointestinal tract. Zinc can be used long-term for maintenance therapy in Wilson's disease patients, including during pregnancy where it has been shown to be safe. The document also discusses combinations of zinc and penicillamine, noting some studies have found higher mortality with this combination compared to other therapies.
The panel discussion focused on developmental, speech, psychiatric and counseling issues related to Wilson's disease. The panelists were experts in neurology, speech pathology, psychiatry and counseling. Key topics discussed included:
- Common neurological and psychiatric manifestations of Wilson's disease including movement disorders, dysarthria, and behavioral/mood changes.
- The importance of considering Wilson's disease in young patients presenting with recent neuropsychiatric symptoms that are treatment resistant.
- Challenges in diagnosing and managing dominant psychiatric presentations of Wilson's disease.
- The role of various specialists like speech therapists and counselors in addressing issues related to speech, behavior, rehabilitation and quality of life in patients with Wilson's
Hepatic and Neuro Wilson disease - Is there a difference? - Dr John MatthaiSanjeev Kumar
This document discusses the differences between hepatic and neurological involvement in Wilson disease. It notes that the pathophysiology of how copper overload leads to liver vs. brain disease is not fully understood. The document then lists several clinical observations that may provide clues about the pathophysiology: 1) Not all copper overload syndromes affect both the liver and brain. 2) Neurological disease can sometimes occur without liver involvement in Wilson disease patients. 3) Copper chelating treatments can improve both liver and neurological symptoms.
Diagnostic challenges in Wilson disease: do scoring systems help? - Dr Harsha...Sanjeev Kumar
This document discusses diagnostic challenges in Wilson disease and whether scoring systems help. It summarizes that experts view hepatic and neuropsychiatric Wilson disease differently. It then discusses several prognostic scoring systems used for acute liver failure, including Child-Pugh, MELD, and Nazer scores. Data is presented on etiologies of acute liver failure from studies in India. Scoring systems for Wilson disease are also discussed, noting they have variable sensitivity and many patients who died could not undergo testing. The take home message is that appropriate combinations of symptoms, signs, and screening tests are usually adequate for diagnosis, and the main challenge is considering Wilson disease initially.
Panel Discussion - Genetics - Is there a role in clinical practice? - Dr Seem...Sanjeev Kumar
Genetic testing plays an important role in the diagnosis and management of Wilson disease (WD), though it cannot replace standard biochemical tests. In the presented cases:
1) Genetic testing confirmed diagnosis in a child with classic WD, and showed that a negative result did not rule out WD given genetic heterogeneity.
2) It was useful for family screening and managing a fulminant case.
3) It was the preferred method for screening asymptomatic siblings.
4) While it did not replace liver biopsy, it provided additional information in inconclusive cases.
5) Treatment should not be based on genetic results alone without biochemical abnormalities.
Genetic counseling was recommended for families planning pregnancy due
Choice and Monitoring of drug therapy - Dr Ashish BavdekarSanjeev Kumar
Wilson's disease is treated with chelating agents like penicillamine or trientine to reduce copper levels over 6-12 months. Zinc is used long-term to maintain a negative copper balance. Patients require lifelong monitoring clinically and through liver enzymes and urinary/serum copper levels to determine treatment effectiveness, compliance, and adverse effects. Biochemical improvement can take variable times from months to years.
Copper in health and disease - Dr Srinivas SankaranarayananSanjeev Kumar
Copper is an essential trace element that plays an important role in many biological processes as a co-factor in enzymes. Both copper deficiency and toxicity can cause disease. Copper homeostasis is tightly regulated in the body by transport proteins like ATP7A and ATP7B, as free copper above certain levels can be toxic. Genetic mutations in ATP7B can cause Wilson's disease, characterized by copper accumulation in tissues. While Indian Childhood Cirrhosis was once thought to be caused by excess copper intake, it has disappeared as copper utensils were replaced, suggesting other etiologies. There is increasing evidence for the role of copper in neurodegenerative diseases like Alzheimer's through oxidative stress mechanisms.
Why did d-penicillamine disappear from the market?Sanjeev Kumar
This document summarizes a talk on the shortage of the drug penicillamine in India. It discusses that penicillamine disappeared from the market in mid-2016 due to lack of raw material supply from China. The official reason was that the raw material supplier was unavailable, but the actual reasons may have been that the drug came under price control and suppliers did not want to provide raw materials at a competitive price. It also discusses the roles of the Central Drugs Standard Control Organization and National Pharmaceutical Pricing Authority in regulating drug prices and availability in India. The real issue highlighted is India's increasing dependence on China for drug ingredients and the need to support domestic bulk drug manufacturing.
Complications of drug therapy - Dr Malathi SathiyasekaranSanjeev Kumar
1) The document discusses various drug therapies for Wilson disease including penicillamine, zinc, trientine, and tetrathiomolybdate.
2) Penicillamine has severe side effects in 30% of patients including kidney toxicity, lupus-like syndrome, and bone marrow suppression. Its complications can be both direct chemical toxicity or immune-mediated.
3) Zinc has very few side effects but can cause gastric irritation. It is less likely than other drugs to cause neurological deterioration.
How do we monitor neurological improvement - Dr Rukmini MridulaSanjeev Kumar
This document discusses monitoring neurological improvement in patients with Wilson's disease undergoing treatment. It outlines several scales that can be used to stage and monitor patients, including the Chu staging scale and the Global Assessment Scale for Wilson's Disease. When monitoring therapy, clinicians should watch for worsening of symptoms and slowly titrate medications to avoid deterioration. Investigations like urinary copper levels and serum markers can provide information on treatment compliance and effectiveness, while repeat neuroimaging and clinical exams over time assess neurological recovery. Persisting tremors may require additional interventions like thalamotomy.
Wilsons disease and hepatitis dr. abhamoni baroSanjeev Kumar
Case: Prolonged acute hepatitis – is there more to it?
Presenter: Abhamoni Baro
Moderator: Ashish Bavdekar
Panelists: Prakash Vaidya, Harshad Devarbhavi, Seema Alam
Child with acute liver failure dr. kirtichandra kodaliSanjeev Kumar
A 3-year-old boy presented with fever, cough, loose stools and increasing drowsiness over the past few days. On examination, he showed signs of dehydration and liver enlargement. Laboratory tests found elevated liver enzymes and ammonia levels, indicating acute liver failure. The cause was determined to be paracetamol toxicity from an accidental overdose, as serum paracetamol levels were found to be toxic. The patient was treated with N-acetyl cysteine and supportive care, and his condition improved such that his liver function normalized and he was discharged.
Hepatomegaly with seizures and hepatitis in a family dr. rajesh kumar meenaSanjeev Kumar
Case: Hepatomegaly with seizures and hepatitis in a family
Presenter: Rajesh Kumar Meena
Moderator: Vidyut Bhatia
Panelists: Seema Alam, Alka Jadhav, Anshu Srivastava
ISO/IEC 27001, ISO/IEC 42001, and GDPR: Best Practices for Implementation and...PECB
Denis is a dynamic and results-driven Chief Information Officer (CIO) with a distinguished career spanning information systems analysis and technical project management. With a proven track record of spearheading the design and delivery of cutting-edge Information Management solutions, he has consistently elevated business operations, streamlined reporting functions, and maximized process efficiency.
Certified as an ISO/IEC 27001: Information Security Management Systems (ISMS) Lead Implementer, Data Protection Officer, and Cyber Risks Analyst, Denis brings a heightened focus on data security, privacy, and cyber resilience to every endeavor.
His expertise extends across a diverse spectrum of reporting, database, and web development applications, underpinned by an exceptional grasp of data storage and virtualization technologies. His proficiency in application testing, database administration, and data cleansing ensures seamless execution of complex projects.
What sets Denis apart is his comprehensive understanding of Business and Systems Analysis technologies, honed through involvement in all phases of the Software Development Lifecycle (SDLC). From meticulous requirements gathering to precise analysis, innovative design, rigorous development, thorough testing, and successful implementation, he has consistently delivered exceptional results.
Throughout his career, he has taken on multifaceted roles, from leading technical project management teams to owning solutions that drive operational excellence. His conscientious and proactive approach is unwavering, whether he is working independently or collaboratively within a team. His ability to connect with colleagues on a personal level underscores his commitment to fostering a harmonious and productive workplace environment.
Date: May 29, 2024
Tags: Information Security, ISO/IEC 27001, ISO/IEC 42001, Artificial Intelligence, GDPR
-------------------------------------------------------------------------------
Find out more about ISO training and certification services
Training: ISO/IEC 27001 Information Security Management System - EN | PECB
ISO/IEC 42001 Artificial Intelligence Management System - EN | PECB
General Data Protection Regulation (GDPR) - Training Courses - EN | PECB
Webinars: https://pecb.com/webinars
Article: https://pecb.com/article
-------------------------------------------------------------------------------
For more information about PECB:
Website: https://pecb.com/
LinkedIn: https://www.linkedin.com/company/pecb/
Facebook: https://www.facebook.com/PECBInternational/
Slideshare: http://www.slideshare.net/PECBCERTIFICATION
A Strategic Approach: GenAI in EducationPeter Windle
Artificial Intelligence (AI) technologies such as Generative AI, Image Generators and Large Language Models have had a dramatic impact on teaching, learning and assessment over the past 18 months. The most immediate threat AI posed was to Academic Integrity with Higher Education Institutes (HEIs) focusing their efforts on combating the use of GenAI in assessment. Guidelines were developed for staff and students, policies put in place too. Innovative educators have forged paths in the use of Generative AI for teaching, learning and assessments leading to pockets of transformation springing up across HEIs, often with little or no top-down guidance, support or direction.
This Gasta posits a strategic approach to integrating AI into HEIs to prepare staff, students and the curriculum for an evolving world and workplace. We will highlight the advantages of working with these technologies beyond the realm of teaching, learning and assessment by considering prompt engineering skills, industry impact, curriculum changes, and the need for staff upskilling. In contrast, not engaging strategically with Generative AI poses risks, including falling behind peers, missed opportunities and failing to ensure our graduates remain employable. The rapid evolution of AI technologies necessitates a proactive and strategic approach if we are to remain relevant.
Introduction to AI for Nonprofits with Tapp NetworkTechSoup
Dive into the world of AI! Experts Jon Hill and Tareq Monaur will guide you through AI's role in enhancing nonprofit websites and basic marketing strategies, making it easy to understand and apply.
How to Manage Your Lost Opportunities in Odoo 17 CRMCeline George
Odoo 17 CRM allows us to track why we lose sales opportunities with "Lost Reasons." This helps analyze our sales process and identify areas for improvement. Here's how to configure lost reasons in Odoo 17 CRM
বাংলাদেশের অর্থনৈতিক সমীক্ষা ২০২৪ [Bangladesh Economic Review 2024 Bangla.pdf] কম্পিউটার , ট্যাব ও স্মার্ট ফোন ভার্সন সহ সম্পূর্ণ বাংলা ই-বুক বা pdf বই " সুচিপত্র ...বুকমার্ক মেনু 🔖 ও হাইপার লিংক মেনু 📝👆 যুক্ত ..
আমাদের সবার জন্য খুব খুব গুরুত্বপূর্ণ একটি বই ..বিসিএস, ব্যাংক, ইউনিভার্সিটি ভর্তি ও যে কোন প্রতিযোগিতা মূলক পরীক্ষার জন্য এর খুব ইম্পরট্যান্ট একটি বিষয় ...তাছাড়া বাংলাদেশের সাম্প্রতিক যে কোন ডাটা বা তথ্য এই বইতে পাবেন ...
তাই একজন নাগরিক হিসাবে এই তথ্য গুলো আপনার জানা প্রয়োজন ...।
বিসিএস ও ব্যাংক এর লিখিত পরীক্ষা ...+এছাড়া মাধ্যমিক ও উচ্চমাধ্যমিকের স্টুডেন্টদের জন্য অনেক কাজে আসবে ...
हिंदी वर्णमाला पीपीटी, hindi alphabet PPT presentation, hindi varnamala PPT, Hindi Varnamala pdf, हिंदी स्वर, हिंदी व्यंजन, sikhiye hindi varnmala, dr. mulla adam ali, hindi language and literature, hindi alphabet with drawing, hindi alphabet pdf, hindi varnamala for childrens, hindi language, hindi varnamala practice for kids, https://www.drmullaadamali.com
How to Fix the Import Error in the Odoo 17Celine George
An import error occurs when a program fails to import a module or library, disrupting its execution. In languages like Python, this issue arises when the specified module cannot be found or accessed, hindering the program's functionality. Resolving import errors is crucial for maintaining smooth software operation and uninterrupted development processes.
3. Wilson’s disease at NIMHANS
• Prof HS Swamy : Initiated in late 1970
• Specialized WD clinic: Every Wednesday
Neurologist, Social worker
Free care
• Funded & Non-funded Research Projects
Dissertation : 16
Presentation : 30
Peer- reviewed Publications: 34
• Corpus fund
• Registry of >700 patients with
125 – 150 on regular follow up
0
50
100
150
200
250
300
1970-79 1980-89 1990-99 2000-10
Series1
4. Williams and
Walshe, 1981
(n=60) %
Jha et al, 1998
(n=21) %
Present report,
2006 (n=116)
%
Cortical atrophy 63 9.5 44.8
Ventricular dilatation 73 19.0 44.0
Caudate atrophy NA 9.5 25.0
Brainstem atrophy 55 NA 31.9
Cerebellar atrophy 10 9.5 19.0
Hemispheric hypodensity NA 9.5 29.3
Basal ganglionic
hypodensities
NA NA 19.8
Thalamic hypodensities NA NA 10.3
Brainstem hypodensity NA 28.6 NA
Normal 18 14.3 NA
Taly AB, Meenakshi-Sundaram S, Sinha S, et al. Medicine 2007;82 (2): 112-119
CT Scan Observations in Wilson’s Disease
(n=116)
D Bhattacharya. Follow up study of CT scan brain and clinical correlation in Wilson’s disease.
Thesis submitted towards partial fulfillment for DM degree in Neurology, NIMHANS, Deemed University, (1997)
Putaminal, Pallidal &
White matter hypodenisty
6. Brain MRI changes in Wilson’s disease
• Globus Pallidum,
S. Nigra causes T1
hyperintensity
• Reason:
?Manganese
• A combination of
T2hyperIntensity &
T1hyperintensity is
highly suggestive
of WD
This variable appearance is probably due to
combination of necrosis, cystic changes, gliosis,
and copper accumulation
7. •One hundred patients (M:F::57:43, Age: 19.3±8.9 years) underwent MRI evaluation
•Atrophy: cerebrum (70%), brainstem (66%) and cerebellum (52%)
•Signal Changes: putamen (70%), caudate (61%), thalami (58%), midbrain (49%), pons
(20%), cerebral white matter (25%), cortex (9%), medulla (12%) and cerebellum (10%).
•Characteristic features: T2W globus pallidal hypointensity (34%), ‘Face of Giant panda’ sign
(12%), T1W striatal hyperintensity (6%), central pontine myelinosis (7%) and bright claustral
sign (4%) were also detected.
•Clinico-MRI correlation: MRI correlated with disease severity scores (p< 0.001) but did not
correlate with the duration
•MRI changes were diverse and universal in symptomatic patients and involved almost all
the structures of the brain
8. MRI observations in WD
Parameter Roh
(1994)
Wassenaer
(1996)
King
(1996)
Saatci
(1997)
Sinha et al
(2006)
Number of
Patients
25 50 (49 MRI) 25 30 100
Treatment status
Drug naïve 0(0%) 3(6%) 0(0%) NA 18(18%)
Abnormal MRI All(100%) NA 22(88%) 23(76.6%) 93(93%)
Signal intensity changes (%)
Putamen 68 36 86 85.7 72
Globus Pallidus 20 22 41.1 88.8 40
Thalamus 92 18 54 47.6 58
Caudate NA 8 45 42.8 61
White matter 4 22 59 NA 25
Midbrain 76 22 77 76.2 49
Pons 68 18 82 85.7 20
Medulla NA NA NA NA 12
Cerebellum NA 8 50 NA 10
Atrophy (%)
Diffuse/cerebral 88 39 80 100 70
Brainstem NA NA NA NA 66
Cerebellum NA NA NA NA 52
Sinha S, Taly AB, Ravishankar S et al. Neuroradiology; 2006; 48 (9): 614-621
15. MRI and Wilson’s Disease
Sinha S, Taly AB, Ravishankar S et al. Neuroradiology; 2006; 48 (9): 614-621
Face of
Giant Panda
Bright
Claustrum
CPM like
T1W
HyperIntensity
19. Diffusion Restriction in WD
Internal capsule, G. pallidus Pons: CPM like
• Restricted Diffusion: Correspond to restriction of mobility of water molecules
and indicates the presence of cytotoxic edema (acute ischemia and infarct).
• In WD: Excess copper causes cell injury leading to inflammation & cell death
- represented cell swelling associated with inflammation, hence restriction of
diffusion
20.
21. CPM-like changes in Wilson’s Disease
Sinha S, Taly AB, Ravishankar S et al. J Neuroimaging 2007; 17:286-291
22. CPM in osmotic demyelination Vs WD
• CPM- like changes in WD share some similarity
with CPM secondary to ‘osmotic demyelination’.
• But, CPM- like changes in WD might differ in
certain other aspects like
– a) occurs in the setting of a chronic disease without any
obvious evidence of sodium imbalance,
– b) it is almost always contiguous with midbrain signal
changes mainly of tectal region,
– c) has two additional but distinct ‘bisected’ and
‘trisected’ patterns,
– d) infrequent occurrence of EPM.
23. Sinha S, Taly AB, Ravishankar S et al. J Neuroimaging 2007; 17:286-291
CPM-like changes in
Wilson’s Disease
24. MRI correlates of Neuropsychological deficits in Wilson’s Disease
(n=12)
• Tools
NIMHANS Neuropsychology Battery (2004): Administered with norms
considering age, education & gender
• Observations
Universal and variable deficits in domains of motor speed, sustained attention,
executive functions- in working memory, verbal fluency, set-shifting ability,
verbal learning & visual memory, information processing & encoding
• Putative Substrate
Frontal-subcortical & Frontal lobe involvement
Temporal lobe involvement: Rare
Hegde S, Sinha S, Rao S, Taly AB. Cognitive evaluation in Wilson’s disease. Neurology India 2010; 58(5): 708-713
25. Seizures in Wilson’s disease: Magnetic Resonance Imaging
(n=11)
Prashanth LK, Sinha , Taly AB. Seizures in Wilson’s Disease. J Neurol Sci 2010; 291:44-51
14 year girl
with 2 years
h/o WD:
Recurrent
seizures -
response to
de-coppering
agents & AEDs
unsatisfactory.
26. Wilson’s disease: MR spectroscopy and Clinical correlation
H MRS
P MRS
Forty patients & 30
controls underwent in-
vivo 2-D 31P and 1H
MRS of basal-ganglia
using an image-selected
technique.
There was reduced
breakdown and/or
increased synthesis of
membrane
phospholipids and
increased neuronal
damage in basal ganglia
in patients with WD
Sinha S, Taly AB, Ravishankar S, et al. Wilson’s disease: 31P and 1H MRS. Neuroradiology 2010;52(11):977-85
27. • We evaluated white matter (WM) abnormalities in 15 patients with drug naïve Wilson's
disease (WD) and 15 controls using the technique of diffusion tensor imaging (DTI).
• Fractional anisotropy (FA) and mean diffusivity (MD) values were analyzed
• Six patients showed lobar WM signal changes on T2-Weighted (T2W)/ Fluid attenuation
inversion recovery (FLAIR) images while remaining had normal appearing WM.
• MD was significantly increased in the lobar WM, bilateral IC and midbrain of WD
patients. FA was decreased in the frontal and occipital WM, bilateral IC, midbrain and
pons.
• Normal-appearing white matter on FLAIR images showed significantly increased MD and
decreased FA values in both frontal and occipital lobar WM and IC compared with those
in controls.
• Correlation of clinical scores and DTI metrics revealed positive correlation between
neurological symptom score (NSS) and MD of anterior limb of right internal capsule, Chu
stage and MD of frontal and occipital WM.
• Negative correlation was observed between the Modified Schwab and England Activities
of Daily Living (MSEADL) score and MD of bilateral frontal and occipital WM and IC.
• Conclusions: This is the probably the first study to reveal widespread
alterations in WM by DTI metrics in drug naïve WD. DTI analysis revealed
lobar WM abnormalities which is less frequently noted on conventional MRI
and suggests widespread WM abnormalities in WD. It may be valuable in
assessing the true extent of involvement and therefore the severity of the
illness.
28. • We evaluated the usefulness of Diffusion Tensor Imaging (DTI) metrics in
confirmed patients with Wilson’s disease (WD) who are either drug naïve
(n=15) or on de-coppering therapy (n=15) and healthy control (n=15).
Diffusion weighted & tensor imaging (DWI / DTI) in WD
FA maps (b=800 s/mm2 images) shows
ROI in white matter, basal ganglia,
thalamus, and midbrain regions
Mean diffusivity (MD) maps (b=800 s/mm2 images) shows ROI
in cerebral white matter, basal ganglia, thalamus, midbrain,
pontine and cerebellar white matter regions
• First comprehensive report of DTI findings in patients with Wilson’s disease.
• Abnormalities in DTI findings (high MD and FA) were noted in WD compared
to controls and more so in drug-naïve patients
• DTI showed additional tissue abnormalities in WD in various regions of brain
where conventional MRI sequences were normal.
• Differential involvement and variable degree of phenotypic-DTI correlation
was noted Jadav R, Saini J, Sinha S, et al Metabolic brain disease 2013; 28:455-62
29. Role of imaging in following patients
• Clinical & MRI improvement pari-passu in
most patients with neuropsychiatric form
• Liver involvement: Additional clue
• Newer tools - DTI metrics & MRS:
improving understanding at microstructural
levels
• Extensive MRI (+WM) changes: Helps in
prognostication
Sinha S, Taly AB, Prashanth LK et al. BJR 2007; 80:744-749
Lawrence et al, JIMD reports. 2016 vol 25: pp 31-38
30. Wilson’s disease (WD) is clinically & radiologically a dynamic disorder: 50 patients
were recruited prospectively for this study to evaluate the serial MRI and clinical
changes
Serial imaging: Improvement in MRI parameters - 35, No significant changes - 10,
Worsening - 4 and An admixture of resolving and evolving changes - 1.
MRI score improved from 8.2±5.7 to 5.9±6.6.
Patients with extensive changes, white-matter involvement and severe diffuse
atrophy had a poor prognosis
Conclusions: Majority of patients of WD on treatment showed variable
improvement in clinical and MRI features
31. Sinha S, Taly AB, Prashanth LK et al. BJR 2007; 80:744-749
Serial MRI and Wilson’s Disease
Improvement Improvement
Improvement Improvement
Worsening Differential
change
32. Objective: The purpose is to evaluate white matter (WM) abnormalities in 15 patients with Wilson's disease &
15 controls (WD) using the technique of diffusion tensor imaging (DTI).
Methods: DTI/conventional MRI was acquired (3T MRI): Fractional anisotropy (FA) and mean diffusivity (MD)
values were extracted from regions of interest placed in pons, midbrain, bilateral frontal and occipital cerebral
white matter, bilateral internal capsules (IC), middle cerebellar peduncles (MCP) and corpus callosum (CC).
Results: S
Six patients showed lobar WM signal changes on T2-Weighted (T2W)/ Fluid attenuation inversion recovery
(FLAIR) images while remaining had normal appearing WM. MD was significantly increased in the lobar WM,
bilateral IC and midbrain of WD patients.
FA was decreased in the frontal and occipital WM, bilateral IC, midbrain and pons. Normal-appearing white matter
on FLAIR images showed significantly increased MD and decreased FA values in both frontal and occipital lobar
WM and IC compared with those in controls.
Correlation of clinical scores and DTI metrics revealed positive correlation between neurological symptom score
(NSS) and MD of anterior limb of right internal capsule, Chu stage and MD of frontal and occipital WM. Negative
correlation was observed between the Modified Schwab and England Activities of Daily Living (MSEADL) score
and MD of bilateral frontal and occipital WM and IC.
Conclusions: This is the probably the first study to reveal widespread alterations in WM by
DTI metrics in drug naïve WD. DTI analysis revealed lobar WM abnormalities which is less
frequently noted on conventional MRI and suggests widespread WM abnormalities in WD. It
may be valuable in assessing the true extent of involvement and therefore the severity of the
illness.
33. WD (Neurological form) & DD:
How MRI can help?
• Helps to exclude mimickers
• Assists in deciding tests to exclude other
DD
• Some of the MRI findings: almost
pathognomonic of WD
35. A B C D
E F G H
Nagappa et al, JCoN 2016;27:91-94
36.
37. Imaging: Important observations
• CT scan: careful interpretation is essential and normal CT
scan do not exclude WD
• MRI: Definitely useful – often provide clue if not clinically
suspected
– Hepatic form: T1W pallidal hyperintensity
– Always abnormal in neurologically involved patients
– Extent & severity of changes: Protean
– Clinically severe form=extensive MRI changes
– Common: Putamen, thalami, caudate, midbrain, pons,
white matter
– Characteristics: Midbrain tectal change, CPM like
changes, Face of giant panda
38. Imaging: Important observations
– T1W pallidal hyperintensity: Liver
– Frontal white matter & adjacent cortical atrophy: Seizures (SE)
– CPM: 3 subtypes –“Mercedes Benz” sign is a novel observation
– Serial MRI: improves variably with decoppering in majority
– CPM like changes: different that those of osmotic demyelination
– Simultaneous involvement of basal ganglia, thalamus and
brainstem are virtually pathognomonic of WD.
– MR Spectroscopy: Evolving knowledge: Provide idea about
metabolites
– Diffusion tensor imaging: Additional areas and might help in
prognosis
– What is intriguing? Clinico-MRI discordance; Basis of
topographic preference; & Genetic-MRI correlation
39. HOPE
Thank you very much!Acknowledgment: Prof AB Taly
& colleagues/residents
& all the patients
Wilson’s disease Clinic
(Late Dr. HS Swamy- 1970s)