Brain and Spinal Cord

Ventriculus terminalis

5th ventricle Dilatation of terminal spinal cord canal

Altman surgical classification of sacrococcygeal teratoma

Type I: primarily external – best prognosis 47% Type II: Dumbell shape with equal external and internal component 34% Type III: mainly internal within abdomen and pelvis 9% Type IV: internal completely 10%, worst prognosis

L2 hydroxyglutaric aciduria

hyperintensity of subcortical white matter normal periventricular white matter hyperintense basal ganglia putamina bilateral cerebellar nuceli hyperintensity

Alexander disease

hyperintensity in subcortica, deep and periventricular white matter hyperintense basal ganglia

Vanishing white matter disease

hyperintensity of deep white matter normal subcortical white matter areas of cavitation

GM2 gangliosidosis

hypomyelination of white matter T1 thalmic hyperintensity, T2 hypointensity

Glutaric aciduria type I

hypoplasia of frontal and temporal insulae open sylvian fissures hyperintensity of posterior putamina

Late infantile neuronal ceroid lipofuscinosis LI-NCL

Diffuse cortical atrophy, sulcal, lateral ventricle enlarged, marked cerebellar atrophy, enlarged 4th ventricle

Schizencephaly

Clefts in brain that extende from cortex to ventricle lined by dysplastic gray matter

Lissencephaly

arrested neuronal migration thick 4 layer cortex hourglass or figure of 8 cerebral hemisphere shape posterior > anterior involvement

Colpocephaly

dilated atrium/occipital horns of lateral ventricle absent corpus callosum vertical posterior course of anterior cerebral artery

Vein of Galen malformation

Vein of Galen malformation

Aneurysmal dilatation of median prosencephalic vein of Markowski due to arteriovenous fistula that occurs in 6-11 weeks of gestation 30% of all pediatric vascular malformationsM:F = 2:1Most common extra cardiac cause of high output cardiac failurePresents with heart failure or hydrocephalus Two types: choroidal and mural. Choroidal has feeders from pericallosal, choroidal or thalamoperforating arteries. Mural has…

Myxopapillary ependymoma

Holoprosencephaly

Acute disseminating encephalomyelitis (ADEM) in children

Introduction Follows an infection (viral) or vaccinationPost infectious inflammatory immune-mediated processFocal neurologic deficits, headache, fever, altered consciousnessMonophasic usuallyCan involve multiple sites in brain and spinal cordFull recovery in children apart from 10-30% which have residual deficitIf episodes relapse in time or in place, consider multiple sclerosis as differentialADEM patients have no residual lesions on follow…

Hydrocephalus

Introduction Any condition where ventricles are enlargedCommunicating hydrocephalus – extra ventricular obstructionNoncommunicating hydrocephalus – intra ventricular obstructionVentriculomegaly – lack of brain parenchyma (atrophy or lack of development)Surgical intervention – role in cases where there is imbalance in CSF production and absorption CSF formed by choroid plexus and drained mostly by brain and spinal cord, to lesser…

Cavum septum pellucidum

80% of babiesDisappears after 6 monthsNo communication with CSFNo ependymal liningIf it extends posteriorly, it is called cavum septum pellucidum et vergae

Virchow Robin spaces

Perivascular spaceTransmit small arteries and veinsRadially orientedSeen as radiating lines in white matterCSF signal in all sequencesAsymmetrically large perivascular spaces often misdiagnosed as lacunar infarctsIn basal ganglia, they are ovoid in shape, obliquely oriented in direction of lenticulostriate vessels. Related to outer fibers of anterior commissureMore evident as brain atrophiesCan be a route of transmission…

Mega cisterna magna

Normal fourth ventricleNormal cerebellumDilatation of CSF posterior to cerebellumSimplest form of Dandy-Walker complex Read more Kollias, Spyros S., William S. Ball Jr, and Erin C. Prenger. “Cystic malformations of the posterior fossa: differential diagnosis clarified through embryologic analysis.” Radiographics 13.6 (1993): 1211-1231.

Dandy-Walker variant

Vermian hypoplasiaCerebellar hemispheres fairly preservedLarge posterior fossaLarge CSF cyst in posterior fossa without any brain stem compressionFourth ventricle is presentMild lifting of torcula Read more Estroff, J. A., M. R. Scott, and B. R. Benacerraf. “Dandy-Walker variant: prenatal sonographic features and clinical outcome.” Radiology 185.3 (1992): 755-758. Wilson, Murray E., et al. “US case of…

Dandy-Walker complex

Absent cerebellum and vermisLarge posterior fossaLarge CSF cyst in posterior fossa that compresses brainstemAbsent fourth ventricleLifting of torculaAbsent falx cerebelliElevated tentorium cerebelli Associated with usually severe cerebral malformationsHas poor prognosis Read more Chang, Miles C., et al. “Sonographic detection of inferior vermian agenesis in Dandy-Walker malformations: prognostic implications.” Radiology 193.3 (1994): 765-770. Laing, Faye C., et…

Chiari 2 malformation

Protrusion of tonsils > 5 mm below foramen magnumHerniation of fourth ventricle and cerebellar vermis below foramen magnumSmall posterior fossaCerebellar hemisphere can herniate superiorly through tectorial incisorHypoplastic corpus callosumTectal plate is beakedBrain stem is flattened and compressedLow torcula Read more Wolpert, Samuel M., et al. “Chiari II malformation: MR imaging evaluation.” American journal of neuroradiology…

Chiari 1 malformation

Protrusion of tonsils > 5 mm below foramen magnumTonsils are sharp and pointed inferiorlyFourth ventricle is slightly low in positionTonsil descent may cause mild medullary compressionCervical cord syrinx may be seenTectal plate is normalCorpus callosum is normal Read more Elster, Allen D., and M. Y. Chen. “Chiari I malformations: clinical and radiologic reappraisal.” Radiology 183.2…

Low cerebellar tonsils

Protrusion of tonsils < 5 mm below foramen magnumTonsils are rounded inferiorlyFourth ventricle is in normal positionTwining’s line –  horizontal line  from tuberculum sella to internal occipital protuberance. This line should traverse midway through the fourth ventricle Read more Elster, Allen D., and M. Y. Chen. “Chiari I malformations: clinical and radiologic reappraisal.” Radiology 183.2…

Myxopapillary ependymoma

WHO grade I lesionIntradural neoplasm of conus medullaris and filum terminale Children and young adultsSlightly M>FChronic low back ache worsening in nightSlow-growingUsually large when diagnosis is madeMass effect causes scalloping of vertebral body, scoliosis and enlargement of neural foramina When hemorrhage occurs within lesion, sudden worsening of clinical symptoms with leg weakness and sphincter disturbancesAlso causes subarachnoid…

Polymicrogyria

Disorder of neuronal organizationOccurs after neuronal migrationExtent of involvement varies from small, isolated, unilateral areas to large bilateral areasOverconvoluted and fused cortex of normal thicknessSometimes associated with CMV or underlying neurometabolic disorder Imaging Broad thickened gyra (mimicking pachygyria) to overconvoluted multiple gyri with irregular outer and inner cortical surfacesMay show dystrophic calcification Read more Glenn,…

Agenesis of septum pellucidum

Not a severe malformationOften an indicator of other malformations – septo-optic dysplasia, holoprosencephaly, Chiari II malformation, schizencephaly, other migration disorders <1% associated with HESX1 gene mutation Imaging Absence of septum pellucidumBox-like configuration of frontal hornsSmall optic nerves and chiasmSmall anterior pituitary glandEctopic bright spot of posterior pituitaryLook for associated malformations: callosal agenesis, holoprosencephaly, cobblestone cortical malformations,…

Holoprosencephaly

1 in 10,000 birthsDisturbance in separation of embryonic prosencephalon into two separate cerebral hemispheresAssociated with chromosomal abnormalities, maternal diabetes3 types based on severity: alobar, semilobar, interhemispheric variant (syntelencephaly) Alobar holoprosencephaly Complete or near complete failure of separation of cerebral hemispheresOften seen in stillbornInfants that survive show abnormal reflexes, tone and seizuresSevere midline facial deformities –…

Bickerstaff encephalitis

Rare acute syndromeSubgroup of ADEMSubtype of anti-GQ1b IgG antibody syndromeInflammation confined to brainstemPreceded by febrile illnessBenign prognosisAtaxia, ocular paresis, impaired reflexesPathogenesis uncertainNo CSF oligoclonal bands Imaging Extensive high T2 signal in midbrain and pons, sometimes in basal ganglia and thalamusLesions resolve with time, good prognosis Read more Mondéjar, R., J. Santos, and E. Villalba. “MRI…

Balo concentric sclerosis

Variant of multiple sclerosisLarge demyelinated lesions with peculiar alternating layers of preserved and destroyed myelinIsolated, multiple or mixed with normal MS type lesionsSimilar lesions seen in cocaine abuse, an autoimmune reaction to levamisole – common cocaine adulterant Imaging Thick concentric T2 hyperintense bands corresponding to demyelination and gliosisIsointense bands represent normal myelinOnion skin, mosaic or…

Schilder disease

Acute or subacute disorderSpecific clinicoradiological presentation of multiple sclerosisAffects children, young adultsPsychiatric predominance, acute intracranial hypertension, intermittent exacerbations, progressive deteriorationWell demarcated demyelination, reactive gliosis, relative sparing of axonsMicrocystic changes, frank cavitationDramatic response to steroids Imaging Ring enhancing lesions in both hemispheresSymmetric, in parieto-occipital regionsMinimal mass effectRestricted diffusion Read more Sarbu, Nicolae, et al. “White matter…

Marburg disease

Rare acute variant of multiple sclerosisSeen in young adultsRapidly progressive courseFrequent severe relapsesDeath or severe disability within weeks to months of onsetPreceded by febrile illnessMonophasic courseAlso considered fulminant form of ADEMMassive macrophage infiltration, demyelination, hypertrophic astrocytes, severe axonal injury Imaging More destructive lesions than in MS or ADEMMultiple focal T2 lesions of different sizes, that…

Frontotemporal lobar degeneration

Tau protein or progranulin mutationLanguage and behavioral symptoms5-10% of all dementiaAutosomal dominant, Chr. 17 Lund-Manchester criteria (3 main subtypes) Behavioral variant frontotemporal dementiaProgressive non-fluent aphasiaSemantic dementia Imaging Asymmetrical atrophy of frontal and temporal lobesSemantic dementia: marked left temporal lobe atrophy (temporal pole > hippocampus)Behavioral variant: frontal lobe atrophy is often mild at time of diagnosis…

Radionecrosis

In white matter adjacent to irradiated cerebral tumorAdjacent brain tissue in field of head and neck tumor radiation therapyRadiation causes cerebral small vessel alterations, wall thickening and direct glial and lesser extent neuronal injury Imaging MRIRing-enhancing lesion, areas of hemorrhage, surrounded by edemaDifficult to distinguish from tumor recurrenceIncreased diffusivity on DWILow cerebral blood volumeLow choline…

Methotrexate neurotoxicity

Usually seen in intrathecal administration of high doses in children Imaging MRIbilateral T2 hyperintense centrum semiovale lesions with diffusion restrictionpartial or totally reversiblealso causes delayed leukoencephalopathy – confluent T2/FLAIR white matter hyperintensities Read more de Oliveira, Arthur M., et al. “Imaging patterns of toxic and metabolic brain disorders.” Radiographics 39.6 (2019): 1672-1695. Vázquez, Elida, et al. “Side…

Posterior reversible encephalopathy syndrome

Due to severe hypertension (eclampsia), chemotherapy, transplantation, immunosuppressive therapy (ciclosporin), autoimmune diseasesDysfunction of posterior cerebral arterial circulationSecondary cerebral vasogenic edema and/or vascular endothelial damageHeadache, seizures, confusion, cortical blindness, cerebellar syndrome, consciousness disorders Imaging MRIbilateral cortico-subcortical T2 confluent hyperintensities, mainly in watershed parietal and occipital lobesbrainstem and deep cerebral nuclei may be involvedDWI shows increased diffusivity…

Carbon monoxide poisoning

Affinity of carbon monoxide for Hb is 250 times for than oxygenCarboxyhemoglobin reduces oxygen carrying capacity of HbHeadache, tinnitus, dizziness, nauseaSurvivors have severe extrapyramidal disorder or dementiaBilateral globus pallidus necrosis, sometimes involved lenticular nuclei and caudate. Thalami and hippocampi rarely involved. Sometimes distal frontal matter involved Imaging MRIBilateral basal ganglia low T1, high T2Microbleeds may…

Hepatic encephalopathy

Patients with liver dysfunctionCirrhosis, portal hypertension, portal systemic shunts, acute liver failureMRI demonstrates CNS increase in certain substances that are normally metabolized by the liver Imaging MRIT1 high signal in globus pallidum due to excess manganeseElevated glutamate/glutamine peak with decreased myo-inositol and choline on spectroscopy. This is due to hyperammonemiaT1 high signal in anterior pituitaryWhite…

Osmotic demyelination

Occurs if hyponatremia is rapidly correctedThis destroys blood-brain barrier, causes hypertonic fluid accumulation in extracellular space, causes non-inflammatory demyelination, affecting mainly ponsParalysis, dysphagia, dysarthria, pseudobulbar palsyDeath frequent Imaging MRIHigh T2 signal in central pons, with symmetrical trident pattern sparing periphery and corticospinal tractsHypointense on T1Peripheral contrast enhancementRestricted diffusivityIf patient survives, chronic lesions appear as a…

MELAS

Acronym: mitochondrial encephalopathy, lactic acidosis, stroke-like episodesDue to mitochondrial DNA mutationStroke like symptoms, encephalopathy, seizures, myopathyLactic acid in CSFRagged red fibres on muscle biopsy Imaging MRICortico-subcortical T2 hyperintensities in parietal, temporal and occipital lobesTopography does not correspond to single vascular territoryCortical and leptomeningeal contrast enhancementDWI – restriction or increased diffusion depending on phase of lesionsSpectroscopy…

Fabry disease

Diagnosed after 20 years of ageNeurological involvement commonCerebrovascular events – transient ischemic attacks, strokes, chronic cerebral vasculopathy, vessel ectasia in posterior circulation Imaging MRIPeriventricular and subcortical white matter hyperintensities, microbleeds, lacunar infarctsIncreased basilar artery diameterPulvinar sign – exclusive involvement of lateral pulvinar with symmetrical T1 hyperintensity on plain MRI. Rare feature. Read more Gavazzi, Cinzia,…

Chondrocalcinosis

Deposition of CPPD makes articular cartilage and fibrocartilage visible on radiographsSeen in 6-11% of patients with primary hyperparathyroidismAcute pain resembling goutJoint aspiration shows pyrophosphate crystals in 25% casesFeature of primary disease and not secondary to CKD Imaging Seen in radiograph of hand (triangular ligament), knees (cartilage and menisci) and symphysis pubisShoulder and hip less commonly…

Osteosclerosis of spine

Secondary to chronic kidney disease – excess accumulation of poorly mineralized osteoidRarely due to primary hyperparathyroidism – exaggerated osteoblastic response following bone resorption Imaging Affects axial skeletonEndplates preferentially involved in vertebral bodies. Dense bones adjacent to endplates with central band of lower normal bone density. This striped pattern is called ‘rugger jersey’ spine Read more…

Hydatid disease of the brain

Two main types – cystic and alveolar. Cystic more commonDefinitive host – dogIntermediate host – sheep and cattleAccidental host – manInfected via feco-oral transmissionCNS involvement in 4% of casesHematogenous spread of embryos from gastrointestinal tract  Imaging Large, isolated, unilocular, well-defined and thin-walled cystsSmall daughter cysts arranged peripherally within large maternal cyst – pathognomonic of hydatid…

Ligamentum flavum cyst

Arise from or partially embedded within the ligamentum flavumSeldom seenRelated to necrosis or myxoid degeneration in a hypertrophied ligamentum flavumChronic degenerative changes followed by repetitive hemorrhages will form degenerative cystsThese small cysts aggregate to form a single large cyst Imaging Typical location: L4-5Extradural intraspinal mass in close relation to ligamentum flavumNo rim calcification (unlike juxtafacet…

Cerebral toxoplasmosis

Toxoplasma gondii – intracellular protozoan.  Infects humans via cat feces, ingestion of raw or undercooked meat, shellfish, unwashed fruits and vegetablesHealthy patients – asymptomatic, becomes latent in neuroparenchymaLatent infection reactivated when immunocompromised, like HIV when CD4 count drops bellow 100 cells per cu.mm. Pyrimethamine-sulfadiazine and folic acid reduces size of lesions within a fortnight Imaging Ring-enhancing…

Idiopathic intracranial hypertension

Earlier called pseudotumor cerebriUnknown etiologyAffects young obese womenPapilledema Raised intracranial pressure without intracranial cause, meningeal problem or any cerebral venous thrombosisTortuosity and ectasia of optic nerve sheathsFlattening of posterior globesEmpty sella turcicaNarrowing of distal transverse venous sinuses Read more Friedman, Deborah I., and Daniel M. Jacobson. “Diagnostic criteria for idiopathic intracranial hypertension.” Neurology 59.10 (2002): 1492-1495.…

Diagnostic criteria for neurofibromatosis type 1

At least two major criteria makes the diagnosis of neurofibromatosis type 1 Major criteria cafe au lait spotsfreckling in inguinal or axillary areasone plexiform neurofibroma or two neurofibromas of any typevisual pathway gliomatwo or more Lisch nodules of irisdistinctive osseous lesion (sphenoid dysplasia or thinning of cortex)first-degree relative with neurofibromatosis-1 Minor criteria small staturemacrocephalyscoliosispectus excavatushamartomatous…

Alcohol and the brain

Central nervous system depressant primary interfering with GABA receptorsPleasure comes from release of endorphins and dopamine Acute phase usually CT is doneQuite often CT is normalSometimes mild cerebral edema is seen in the form of effacement of sulci and reduced size of ventricles Chronic phase Non specific atrophy: atrophy disproportionate for age and involving all…

Multiple sclerosis

Introduction 40-50 years ageRelapsing-remitting type 85%Primary-progressive type 15%Characteristic abnormality – demyelinating plaquesLocation of plaques – middle cerebellar peduncle, callososeptal interface, periventricular white matter, juxtacorticalCallososeptal interface involvement – pathognomonic Imaging Plaque characterInitial stages: acute, with surrounding edemaRemyelination may occur: resulting in target lesions in pathologyEventually, chronic stage: axon loss, fluid accumulation, gliosisPeriventricular lesionsWhite matter surrounding corpus…

Progressive supranuclear palsy

Introduction ParkinsonismSupranuclear ophthalmoplegiaPseudobulbar palsydementia Imaging Humming bird sign: concave upper mid brain border in sagittal imageMickey mouse sign: reduced anteroposterior mid brain diameter < 14 mm with deepening of interpeduncular cistern

Multiple system atrophy

Introduction Sporadic progressive neurodegenerative disorderAdulthood onsetGlial cytoplasmic inclusions containing alpha synucleinCombination of cerebellar, autonomic, extra-pyramidal and pyramidal signsMSA-P: predominant parkinsonian featuresMSA-C: predominant cerebellar dysfunction Imaging MSA-C: reduced pontine volume. Cerebellar atrophy. Cruciform T2 pontine hyperintensity (hot cross bun sign)MSA-P: also shows excess mineralization of bilateral putamina and substantia nigra

Parkinson’s disease

Introduction Progressive neurodegenerative movement disorderInvolves basal gangliaHypokinetic disorderImpaired initiation of movementReduction in amplitude and velocity of movement1.5 times more common in menUsually after 60 years ageDegeneration of cells in pars compacta of substantia nigraSymptoms appear after 50% of dopaminergic neurons and 80% of striatal dopamine is depleted Clinical picture AsymmetryResting tremorGood response to dopamine replacement…

Normal pressure hydrocephalus

gait disturbancedementiaurinary incontinence communicating hydrocephalusnormal measured pressuremostly idiopathiconly some patients improve with shunting

Chance fracture

horizontal splitting of vertebral bodylittle compressionassociated intra abdominal and neurological injuries mechanism anterior hyperflexion over an object (seatbelt) that acts as a fulcrum posterior ligaments intactif any ligament injury is present, epidural fat will be dirtysoft tissue chance injury: posterior ligament injury without bony injury radiograph transverse/horizontal fracture of spinous process with or without pediclesinvolves…

Clay shoveller’s fracture

C6-T1 spinous process avulsion mechanism rotation of upper trunk with a fixed cervical spine occasionally due to a direct blowstable injury

Flexion teardrop fracture

fracture-dislocation with spinal cord injury mechanism hyperflexion and axial compressionunstable injury radiograph triangular fragment at anteroinferior aspect of involved vertebral body (teardrop)anterior vertebral body height reduction with soft tissue swellingposterior displacement of fractured vertebradiastasic of interfacetal joints longitudinal ligament, intervertebral disc and posterior ligament complex disruption

Hangman’s fracture

traumatic spondylolisthesis of C2 with fracture through both pediclesposterior elements separated from vertebral bodyfracture lines oblique and symmetricalanteroinferior C2 margin may be avulsedC2 body subluxes anteriorly to C3 but posterior elements remain aligned mechanism hyperextension injuryunstable injury

Jefferson fracture

disrupted anterior and posterior arches of atlas mechanism axial compression injury to top of skullstable injury radiograph bilateral offset of lateral masses of C1 relative to lateral margin of C2 vertebral bodywidened space between dens and medial border of C1 lateral masses

Extension tear drop fracture

fracture of anteroinferior corner of body of C2avulsed by an intact anterior longitudinal ligamentno associated neurological deficitoccurs in isolation or with hangman’s fractureoccasionally involves lower cervical vertebral bodies an unstable extension injury

Wilson disease

hepatolenticular degenerationautosomal recessiveexcess copper retentionchromosome 13 alteration – liver unable to excrete copper into bile7-50 yearshepatic findings in childrenneuropsychiatric findings in adults stages Stage 1 asymptomatic copper accumulation in liver cytosolStage 2 redistribution of copper from hepatic lysosomes. when gradual it is asymptomatic, if rapid redistribution, presents with fulminant hepatic failure or acute intravascular hemolysisStage…

Ethanol intoxication

characteristic neuroparenchymal volume lossinitial infratentorial predominance with vermian and cerebellar atrophyfollowed by frontal and temporal atrophy finally diffuse brain atrophy

Commercially available gadolinium-based contrast agents

ACR, FDA and EMA have classified Gadolinium-based contrast agents into three groups GroupTypeUS Trade NameChemical NameIlinear, non-ionicOmniscangadodiamidelinear, non-ionicOptiMARKgadoversetamide linear, ionicMagnevistgadopentate dimeglumineIIlinear, ionicMultiHancegadobenate dimegluminemacrocyclic, non-ionicProHancegadoteridolmacrocyclic, non-ionicGadavistgadobutrolmacrocyclic, ionicDotaremgadoterate meglumineIIIlinear, ionicEovistgadoxetate disodium

Communicating discs to clinicians

The Combined Task Forces classification based on anatomical boundaries used by surgeons transverse / axial plane central (posterior midline)paracentral (right/left central)right/left subarticular (lateral recess)right/left foraminal (neural foramen)right/left extraforaminal (outside neural foramen)anterior zone (anterior and anterolateral) vertical / sagittal plane pedicle levelinfrapedicle leveldisc levelsuprapedicle level

Disc herniation

displacement of disc material beyond limits of intervertebral disc spacewhat is disc material? cartilage, nucleus, fragmented annular tissue and apophyseal bonebreak in vertebral end plates or disruption in annulus fibrosus needed for herniation to occur TYPES extrusion base against the disc is smaller than diameter of displaced disc material (measured in same plane ax or…

Disc bulge

circumferential or generalized disc displacement>50% of disc circumference etiology physiological at L5-S1advanced degenerative changespseudo image due to partial volume effectrelated to bone remodeling or ligament laxity types symmetrical – uniform in all directionsasymmetrical – seen in scoliosis

Limbus vertebra

in young individualsherniation of nucleus pulposus through ring apophysis before bony fusionas a result small segment of vertebral rim gets isolatedmore common in lumbar region, less common in mid cervical leveldefect in anterior wall of vertebra usually in anterior superior margin lumbar spine and anterior inferior margin in cervical spine

Schmorl’s nodes

also called intervertebral herniationsdisc displacement through one or both vertebral end platesbreak in vertebral end plates or disruption of annulus fibrosussurrounded by reactive bone marrow changeshypothesis: regression of nutrient vascular canals in the end plate causes a weak spot resulting in herniation

Modic vertebral degeneration

degenerative changes in vertebral end plates and bodies described by Modic in 1988 type I decreased signal intensity on T1increased signal intensity on T2inflammatory stage shows bone marrow edema type II increases signal intensity on T1 increased or intermediate signal intensity on T2fatty stagelocal fatty replacement of bone marrow type III decreased signal intensity on…

Superior view of skull

Orbital surface of frontal lobe

Lines of craniovertebral junction

Ventricular system of brain

Normal myelination

Cranial nerves

Venous drainage of brain

Acute subdural hemorrhage

Clinical presentation Worsening headache in a mid 70s gentleman. History of mild head trauma couple of days ago. CT Brain https://www.youtube.com/watch?v=UODeqekuT8A https://www.youtube.com/watch?v=SF3GwLBEH4w https://www.youtube.com/watch?v=kEuP62pn22Q https://www.youtube.com/watch?v=l61dGiySFu4 Findings Bilateral frontoparietotemporal convexity extra axial hemorrhage with dependent varying density within is seen, more on the left side, causing compression of bilateral supratentorial neuroparenchyma, mild midline shift to right, effacement…

Fetal lumbar meningocele and hydrocephalus

Clinical presentation Primi detected to have fetal prominent lateral ventricles in 5 months anomaly scan. Came for routine follow up 8 months scan Fetal USG Findings Lower lumbar spinal defect with herniation of spinal sac posteriorly. There is accompanying gross dilatation of lateral ventricles with thinning of supratentorial neuroparenchyma. Discussion Careful analysis of spine in…

Hypoxic ischaemic encephalopathy

Clinical presentation 55 year old gentleman had a cardiac arrest and was resuscitated. Remains unconscious since the event. MRI https://www.youtube.com/watch?v=sMfO8wbkyaY https://www.youtube.com/watch?v=uh6zBmPzd6M https://www.youtube.com/watch?v=YKHI_I4eCjw https://www.youtube.com/watch?v=tEVg7lDYaVY https://www.youtube.com/watch?v=copS5GJojAA https://www.youtube.com/watch?v=NVqNB4-WrIs Findings Global hypoxic insult involving supratentorial neuroparenchyma in the form of diffuse grey matter restriction, involving deep grey matter nuclei as well. Focal hemorrhage in genu of corpus callosum, likely…

Acute right MCA territory infarction

Clinical presentation 65 year old gentleman presented with acute onset left sided weakness since waking up in the morning. CT https://www.youtube.com/watch?v=AHra6mKjfXI   MRI https://www.youtube.com/watch?v=_1Dg0mcHOeU Findings Scattered areas of hypoattenuation are seen involving the subcortical and deep white matter of right frontal lobe, corona radiata and external capsule. Diffusion weight MR images confirm restriction in keeping…

Arachnoid cyst

20 year old gentleman came to the ER following a motor vehicle accident. Routine CT brain was asked for to rule out any internal injury. CT Findings no intra axial or extra axial hemorrhage. no calvarial fracture. large extra axial CSF attenuating lesion is seen occupying the left middle cranial fossa splaying the sylvian fissure…

Myelination age- MRI

Adapted from pediatric neuroimaging, Barkowich. 

Sulcation of brain – chronology

* adapted from textbook of pediatric neuroimaging – Barkowich

Crossed cerebellar diaschisis

Patient 1 50 year old gentleman, a known old CVA patient presented with acute onset right sided weakness. Emergency CT was done to rule out reinfarction. Findings Large intracerebral fresh hemorrhage is seen in the left supratentorial parenchyma. Old ischemic changes seen in right cerebral hemisphere. Asymmetric subtle hypoattenuation is seen involving the right superior…

Hypoxic ischaemic injury in term neonates

Lumbar disc nomenclature

Techniques in pediatric neuroimaging