Splenium hyperintensity
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The document describes MRI findings for two patients. For the first patient, a 16-year-old male who fell from a train, the MRI shows diffuse axonal injuries with lesions in multiple areas of the brain along with a small subdural hematoma and skull fracture. For the second patient, a 47-year-old male with fever and possible seizures, the MRI reveals a small area of restricted diffusion in the splenium of the corpus callosum, which can be seen in various conditions including postictal edema, diffuse axonal injury, infections like dengue, and trauma. Clinical correlation is recommended.
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Recklinghausen's disease. Neurological examination revealed spastic quadriparesis, prominent in the left extremities. Posterior column sensations were lost in all four limbs. Deep tendon reflexes were exaggerated in all four limbs. A positive Hoffman s and Babinsky signs and sign were present bilaterally. Gait was broad-based due to spasticity. Difficulty in urination was present .MRI of cervical spine was done at some other institute revealed a large well defined homogenously enhancing intradural extramedullary mass at C1-2 level on left side markedly compressing the cord, there was associated cord edema at adjacent cervical levels(fig.1&2). A provisional diagnosis of schwannoma or neurofibroma was kept since there was no dural tail or broad based attachment of tumor to dura.
Patient was advised surgical removal of tumour . Tumor was approached via midline incision in neck and C-1 to C-3 laminectomy was done. Dura was opened under microscope and tumor was found on left side and whole of the tumor was intra arachnoidal. To our surprise though tumor was mainly extra medullary on left side ,it had an intra-medullary extension. Extramedullary component was completely removed followed by intatumoral decompression of intra medullary part.Capsule of intramedullary component was densely adherent to spinal cord and small amount of tumor tissue had to be left behind to avoid post operative neurological deficit(fig.4). Duraplasty was done. In the postoperative period the power of the patient improved gradually and by the end of the first week she could walk without support and at the end of one month power in all four limbs was 5/5 , though spasticity remained in all four limbs. Her gait remain broad based and there is clumsiness while walking.
DISCUSSION
Intramedullary schwannomas are rare tumors . The first surgical description of a spinal tumor was made in 1888 by Sir Victor Horsley(3). In 1907 Von Eiselberg published the successful resection of an intramedullary neurofibrosarcoma. First intramedullary schwannoma was reported by Kernohanin1952 though Penfield had already described an intramedullary lesion with schwannoma characteristics in 1932(4).
We found 52 cases in the literature, in addition to our case. Of these cases only three have been reported as having both intramedullary and extramedullary component . Gorman etal., have reported the extramedullary component to be an exophytic extension of the intramedullary tumor from the enlarged spinal cord(5).
Mean age at presentation of these lesions is 40-years . They are usually single lesions affecting the cervical spinal cord (63%), the thoracic spinal cord (26%) and the lumbar spinal cord (11%). They have a slow growth pattern and because of this the average interval between first symptoms and diagnosis is 28.2 months (from six months to 20 years)(6). The most described clinical manifestation is the pyramidal syndrome followed by sensitivity complaints and sphincter dysfunctio
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2) It reports on 108 patients who underwent aortic arch surgery using unilateral right antegrade cerebral perfusion via cannulation of the right axillary or innominate artery.
3) The results showed low mortality and neurological deficit rates, suggesting unilateral cerebral perfusion is adequate for aortic arch surgery in most cases, though bilateral perfusion is needed if left cerebral saturation decreases significantly.
Spontaneous vertebral artery dissection –a case report (1)
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This patient presented with multiple abrasions and a large bleeding wound on his left thigh after falling 9 meters. He had lost a significant amount of blood due to a laceration of his right femoral artery and was at risk of hemorrhagic shock. Evidence supporting the diagnosis included the mechanism of injury from the fall, appearance of the blood-soaked thigh, use of a tourniquet over the groin laceration, weak pulses, orthostatic hypotension, elevated creatinine and liver enzymes, pale skin, disorientation, and decreased central venous pressure.
Chronic Subdural Hematoma Presenting with Kernohan-Woltman Notch Phenomenon: ...
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This case report describes a 50-year-old man who presented with sudden loss of consciousness due to a chronic subdural hematoma, which caused Kernohan-Woltman notch phenomenon (KWNP). KWNP occurs when a supratentorial brain lesion displaces brain tissue, compressing the contralateral cerebral peduncle against the tentorial edge and causing ipsilateral hemiparesis. The patient underwent burr hole drainage surgery and regained consciousness, but had residual left-sided hemiparesis and mydriasis, confirming KWNP. This represents the first reported case of chronic subdural hematoma causing KWNP in Ghana.Spinal stroke
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Recklinghausen's disease. Neurological examination revealed spastic quadriparesis, prominent in the left extremities. Posterior column sensations were lost in all four limbs. Deep tendon reflexes were exaggerated in all four limbs. A positive Hoffman s and Babinsky signs and sign were present bilaterally. Gait was broad-based due to spasticity. Difficulty in urination was present .MRI of cervical spine was done at some other institute revealed a large well defined homogenously enhancing intradural extramedullary mass at C1-2 level on left side markedly compressing the cord, there was associated cord edema at adjacent cervical levels(fig.1&2). A provisional diagnosis of schwannoma or neurofibroma was kept since there was no dural tail or broad based attachment of tumor to dura.
Patient was advised surgical removal of tumour . Tumor was approached via midline incision in neck and C-1 to C-3 laminectomy was done. Dura was opened under microscope and tumor was found on left side and whole of the tumor was intra arachnoidal. To our surprise though tumor was mainly extra medullary on left side ,it had an intra-medullary extension. Extramedullary component was completely removed followed by intatumoral decompression of intra medullary part.Capsule of intramedullary component was densely adherent to spinal cord and small amount of tumor tissue had to be left behind to avoid post operative neurological deficit(fig.4). Duraplasty was done. In the postoperative period the power of the patient improved gradually and by the end of the first week she could walk without support and at the end of one month power in all four limbs was 5/5 , though spasticity remained in all four limbs. Her gait remain broad based and there is clumsiness while walking.
DISCUSSION
Intramedullary schwannomas are rare tumors . The first surgical description of a spinal tumor was made in 1888 by Sir Victor Horsley(3). In 1907 Von Eiselberg published the successful resection of an intramedullary neurofibrosarcoma. First intramedullary schwannoma was reported by Kernohanin1952 though Penfield had already described an intramedullary lesion with schwannoma characteristics in 1932(4).
We found 52 cases in the literature, in addition to our case. Of these cases only three have been reported as having both intramedullary and extramedullary component . Gorman etal., have reported the extramedullary component to be an exophytic extension of the intramedullary tumor from the enlarged spinal cord(5).
Mean age at presentation of these lesions is 40-years . They are usually single lesions affecting the cervical spinal cord (63%), the thoracic spinal cord (26%) and the lumbar spinal cord (11%). They have a slow growth pattern and because of this the average interval between first symptoms and diagnosis is 28.2 months (from six months to 20 years)(6). The most described clinical manifestation is the pyramidal syndrome followed by sensitivity complaints and sphincter dysfunctio
Poster Houston
1) The document discusses the safety and effectiveness of unilateral antegrade cerebral perfusion in aortic arch surgery.
2) It reports on 108 patients who underwent aortic arch surgery using unilateral right antegrade cerebral perfusion via cannulation of the right axillary or innominate artery.
3) The results showed low mortality and neurological deficit rates, suggesting unilateral cerebral perfusion is adequate for aortic arch surgery in most cases, though bilateral perfusion is needed if left cerebral saturation decreases significantly.
Spontaneous vertebral artery dissection –a case report (1)
A 35-year-old man was admitted to the hospital after experiencing sudden onset of headache, neck pain radiating to his shoulders, and tinnitus that progressed to left-sided weakness over 5 hours. Imaging revealed vertebral artery dissection, which was treated with anticoagulation therapy. The case report discusses vertebral artery dissection as an increasing cause of stroke in young adults and emphasizes including it in the differential diagnosis of neck pain in young patients.
Blunt traumatic injury of the innominate artery resulting in a stroke – A rar...
Blunt traumatic injury of innominate artery is uncommon and has been reported only in 132 cases. In the literature there has been a solitary case report of a stroke resulting from an innominate artery injury. We present a case of traumatic injury of the innominate artery resulting in an ischemic stroke.
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Case: Multiple injured patient
This patient presented with multiple abrasions and a large bleeding wound on his left thigh after falling 9 meters. He had lost a significant amount of blood due to a laceration of his right femoral artery and was at risk of hemorrhagic shock. Evidence supporting the diagnosis included the mechanism of injury from the fall, appearance of the blood-soaked thigh, use of a tourniquet over the groin laceration, weak pulses, orthostatic hypotension, elevated creatinine and liver enzymes, pale skin, disorientation, and decreased central venous pressure.
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Chronic Subdural Hematoma Presenting with Kernohan-Woltman Notch Phenomenon: ...CrimsonPublishersTNN
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Spinal stroke is a rare type of stroke accounting for less than 1% of all strokes. It results from an acute disruption of blood supply to the spinal cord, causing ischemia and neurological deficits. The spinal cord receives its blood supply from the anterior spinal artery and dual posterior spinal arteries. Etiologies of spinal stroke include vertebral artery dissection, arteriosclerosis, embolism, hypotension, and vasculitis. Clinical features appear rapidly within 30-45 minutes and include radicular pain and neurological deficits depending on the affected territory. MRI is important for diagnosis, particularly vertebral body infarction. There is no established effective therapy, but prognosis varies with age and severity, with many patients experiencing some improvement over time.
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Small airways disease refers to pathologies that affect the small conducting airways less than 3mm in diameter. CT scanning is the imaging modality of choice for evaluating small airways disease. On HRCT, direct signs of small airways disease include thickened airway walls, dilated or obliterated airways, and nodules. Indirect signs include air trapping, subsegmental atelectasis, centrilobular emphysema, and centrilobular nodules. Common patterns seen on HRCT include tree-in-bud, poorly defined centrilobular nodules, decreased lung attenuation, and ground glass opacities with consolidation.
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Mesothelioma is a form of cancer that arises from the lining of the lungs (pleura) or abdomen (peritoneum), almost always caused by asbestos exposure. There are three main types - pleural, peritoneal, and pericardial mesothelioma. Mesothelioma typically presents with chest pain and shortness of breath in middle-aged men with a history of asbestos exposure. Diagnosis involves imaging like CT scans and MRI, thoracentesis if a pleural effusion is present, and thoracoscopy with biopsy to confirm. Treatment options include surgery, radiation, chemotherapy and newer approaches like anti-angiogenesis drugs and immunotherapy, but prognosis remains poor with an average survival of 9
Anatomy of the respiratory system
The document summarizes the anatomy and functional structures of the respiratory system. It describes the upper respiratory tract including the nose, nasal cavity, paranasal sinuses, pharynx and larynx. It then describes the lower respiratory tract including the trachea, bronchi, bronchioles and lungs/alveoli. Key structures and their functions are outlined for each part of the respiratory system.
ventilator Associated Pneumonia -By Dr.Tinku Joseph
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This document discusses ground-glass opacities seen on CT scans. It defines ground-glass opacities as a hazy increase in lung opacity while preserving bronchial and vascular markings. Various pathologies can cause ground-glass opacities by partially filling the airspaces. The document then describes different patterns of ground-glass opacities including diffuse, patchy, focal, halo, and peripheral distributions. For each pattern, common diseases that may present with that appearance are listed and briefly characterized.
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Changes in Respiratory System with Various Physiological Conditions
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ventilator Associated Pneumonia -By Dr.Tinku Joseph
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anat quiz.pptx
1. A 70-year-old woman presented with headaches, weakness, and vision issues. MRI showed lesions in the parieto-occipital junction consistent with posterior reversible encephalopathy syndrome (PRES).
2. Autopsy of a 47-year-old woman found dead at home identified a subarachnoid hemorrhage concentrated at the brain base from a ruptured cerebral aneurysm.
3. A 47-year-old man experienced a stroke. Imaging showed a hemorrhage in the left basal ganglia from a ruptured distal lenticulostriate artery aneurysm.
4. A 29-year-old COVID-19 patient developed left hemiplegia
CMC Neuroimaging Case Studies - Cerebral Venous Sinus Thrombosis
Drs. Faith Meyers, Steven Perry, Madison Watts, and Brandon Friedman are Emergency Medicine Residents at Carolinas Medical Center and interested in medical education. Along with the guidance of Dr. Michael Gibbs (Chair of Emergency Medicine), Dr. Jonathan Clemente (Chief of the Department of Radiology and Neuroradiology specialist), Dr. Christa Swisher (Neurocritcal Care Intensivist), and Dr. Scott Wait (Chief of Pediatric Neurosurgery) they aim to help educate us on Neuroimaging. In this presentation they will address Cerebral Venous Sinus Thrombosis. Follow along with the EMGuideWire.com team as they post the CMC Neuroimaging Case Studies.
This set will cover:
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Hyperasthetic ataxic syn aftr thal infarct
Three patients presented with acute onset of ataxic hemiparesis, hypesthesia, and paresthesia on the same side of the body, contralateral to a thalamic infarct. MRI showed lacunar infarction in the ventral lateral nucleus of the thalamus in all patients. The clinical symptoms resolved within 2 months. The article discusses how damage to the dentatorubrothalamic pathway causes ataxia, while initial edema compressing the corticospinal tract explains the brief hemiparesis. Sensory deficits are also attributed to the thalamic lesions.
Neurosurgical Intracranial Infections - FINAL 10-17-23.pptx
Drs. Faith Meyers and Steven Perry are Emergency Medicine Residents and Trent VanHorn is a Neurosurgical Resident at Carolinas Medical Center who are interested in medical education. Along with the guidance of Dr. Michael Gibbs (Chair of Emergency Medicine), Dr. Jonathan Clemente (Chief of the Department of Radiology and Neuroradiology specialist), Dr. Christa Swisher (Neurocritcal Care Intensivist), and Dr. Scott Wait (Chief of Pediatric Neurosurgery) they aim to help educate us on Neuroimaging. In this presentation they will address Atraumatic Neurosurgical Intracranial Infections. Follow along with the EMGuideWire.com team as they post the CMC Neuroimaging Case Studies.
This set will cover:
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Central nervous system
This document contains a series of medical images from CT and MRI scans showing normal brain structures and various brain conditions. Images include normal scans as well as those showing infarctions, hemorrhages, trauma injuries such as fractures and contusions, and various types of tumors including astrocytomas, meningiomas, and metastatic cancers. Each case includes demographic information and a brief description of the clinical findings represented in the images.
Leiomyoma of Skull base
Leiomyoma is a benign tumor that originates from smooth
muscle cell. The most common sites are the uterus, gastrointestinal tract & skin. Leiomyoma is a relatively uncommon smooth muscle tumor rarely found in the head and neck. Enzinger and Weiss (1995), analyzed a total of 7748 leiomyomas, 95% of the tumors occurred in the female genitalia (uterus), 3% in the skin, 0.9% in the gastrointestinal tract and the remainder at various sites including skull base.
Presentation1, radiological imaging of corpus callosum lesios.
1. The corpus callosum is commonly involved by lesions from various etiologies including congenital abnormalities, demyelination, infection, leukodystrophy, neoplasms, trauma, and vascular causes.
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3. Common neoplasms involving the corpus callosum include glioblastoma, which may appear as a "butterfly" lesion crossing the genu, and primary CNS lymphoma presenting with a similar pattern
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Brain tumor imaginig 2 3rd may 02
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Scientific Journal of Neurology & Neurosurgery
Introduction: Envenomation is a public health problem in developing countries. Neurovascular complications are not exceptional.
Observations: We report two cases of hemorrhagic stroke which complicate an envenomation treated late.
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Late onset jugular foramen syndrome following head trauma
A 50-year-old man presented with sudden onset voice changes, nasal regurgitation, nausea and vomiting one day after suffering a severe head injury from a motor vehicle accident. Imaging showed resolving brain contusions and absence of blood flow in the left transverse and sigmoid sinuses, suggesting sinus thrombosis. Examination revealed palsies of the 9th, 10th and 11th cranial nerves on the left side. Further imaging confirmed sinus thrombosis and a skull fracture crossing the left jugular foramen. The patient was managed conservatively and symptoms resolved within a month. Traumatic dural venous sinus thrombosis can occur after head injury via direct compression or endothelial damage causing coagulation. It presents a management challenge due to risk of hemor
Late onset jugular foramen syndrome following head trauma
A 50-year-old man presented with sudden onset voice changes, nasal regurgitation, nausea, and vomiting one day after suffering a severe head injury from a motor vehicle accident. Imaging showed resolving brain contusions and absence of blood flow in the left transverse and sigmoid sinuses, suggesting sinus thrombosis. Examination revealed palsies of the ninth, tenth, and eleventh cranial nerves on the left side. Head trauma can cause sinus thrombosis by direct compression or endothelial damage, leading to clot formation. The patient's symptoms resolved over one month with conservative management. Traumatic dural venous sinus thrombosis is a known complication of head injuries involving skull fractures near sinuses.
Artery of percheron infarct
This case report describes a 56-year-old man who suffered an artery of Percheron infarction. He was found unconscious at home and developed ventricular fibrillation upon arrival at the emergency department. An initial CT scan was wrongly interpreted as normal. A follow-up CT scan 24 days later revealed bilateral ischemia in the paramedian thalamic nuclei and pons, consistent with an artery of Percheron infarction. He died 35 days after hospitalization. Artery of Percheron infarctions are rare and difficult to diagnose due to variability in symptoms and potential for initially normal imaging. This case report aims to increase awareness of this condition.
My Case studies and few Signs in radiology
The document discusses several radiology cases presented by Dr. Santhosh. It includes summaries of individual cases involving findings such as:
1) A gallbladder mass with local invasion and metastatic lesions in an abdominal imaging case.
2) Lucency seen over the liver on an abdominal x-ray of a renal transplant patient, which was later found to be biliary necrosis and abscess on CT scan.
3) Exercise-induced upper extremity deep vein thrombosis in 6 adolescent patients seen at a single center, who experienced poor outcomes with anticoagulation alone.
4) Additional cases involve findings such as diverticulitis, vein of Galen malformation, dandy walker cyst, and renal
Signs in radiology
The document discusses several radiology cases presented by Dr. Santhosh. It includes summaries of individual cases involving findings such as:
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2) Lucency seen over the liver on an abdominal x-ray of a renal transplant patient, which was later found to be biliary necrosis and abscess on CT scan.
3) Exercise-induced upper extremity deep vein thrombosis in 6 adolescent patients seen at a single center, who experienced poor outcomes with anticoagulation alone.
4) Additional cases involve findings such as diverticulitis, vein of Galen malformation, dandy walker cyst, and renal
Imaging of neurocutaneous syndrome overview
This document discusses imaging findings in various neurocutaneous syndromes. It begins with an introduction to neurocutaneous syndromes as multisystem disorders involving the ectoderm. Several specific syndromes are then discussed in more detail, including their diagnostic criteria and common neuroimaging findings. Neurofibromatosis Type 1, Neurofibromatosis Type 2, Sturge-Weber syndrome, and Dyke-Davidoff-Masson syndrome are some of the syndromes covered. For each, characteristic lesions, abnormalities, and imaging appearances are described. Examples of imaging findings from case studies are also presented.
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Multi-modality intraoperative neurophysiological monitoring (IONM) refers to the assessment of neural structures through electrophysiological means during surgery. The document presents 5 case studies demonstrating the use of IONM:
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Case 2 showed transient degradation of median SSEPs during insertion of a spinal shunt, but spontaneous return without intervention.
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Splenium hyperintensity
- 2. 16 year Male patient with history of fall from train on 04.09.13,unconcious since then.
- 5. Axial FLAIR
- 6. Axial FLAIR
- 7. Axial FLAIR
- 8. AxialT2W
- 9. Axial Diffusion Axial Diffusion
- 10. Axial Diffusion
- 11. Axial GRE
- 12. Coronal FLAIR
- 13. Large , ill defined lesion hyperintense on Flair andT2W images in body and splenium.These areas show restricted diffusion. Foci of hemorrhage also seen Similar lesions seen in Right superior frontal parenchyma, bilateral inferomedial temporal parenchyma,right middle cerebellar peduncle,left superior cerebellum,left pons,left crus mid-brain. These findings are suggestive of Diffuse axonal injuries. Small subdural hematoma over right parieto-occipital convexity. A depressed fracture of the right frontal bone is seen.
- 14. 47 yr , Male admitted with – fever with chills since 2 days 1 episode of ? Convulsions Bleeding from mouth. Patient is a known chronic alcohalic
- 15. 10.09.13 – Dengue NS1Ag +ve 11.09.13 – Disoriented EEG- Excess of slow activity on both sides. 12.09.13- Platelets- 23000 12.09.13- MRI
- 17. MR scan reveals, a small area of restricted diffusion in splenium of corpus callosum. This finding is not specific and has been described in postictal edema, diffuse axonal injury, infective causes like dengue and influenza. Clinical correlation is recommended.
- 19. Epilepsy Infection Demylination Metabolic Vascular Miscellaneous Seizures Anti-Epileptic Overdose Abrupt DrugWithdrawlEncephalitis Salmonella Malaria RotaVirus Acute disseminates Encephalomylitis SLE. Cerebro vascular disease Post cardiac arrest Pre eclamsia Posterior reversible encephalopathy syndro Hypertensive encephalopathy Migraine with aura Vitamin B12 deficiency Drug toxicity High altitudinal cerebral edema Trauma- axonal injury Post Radiation Lymphomas Hypoglycemia Hypo/Hyper Na Renal Failure Marchiafava-Bignami disease
- 20. Refractory Epilepsy – Boomerang sign
- 21. Epilepsy with SOL – Boomerang sign
- 22. Migraine pain
- 23. T H A N K Y O U…