Download ABCDES of Arthritis - Long Island Radiological Society

Long Island Radiological Society
Interesting Case Panel
Prepared by Steven Lev, MD
Director of Neuroradiology, NUMC
Tuesday, November 12, 2013
Nassau University Medical Center
East Meadow, NY
Case 1
41 yo hispanic male with 3 month
history of headaches and visual
disturbances.
STOP Proceed to next slide for diagnosis
Racemose Neurocysticercosis
Multiseptated suprasellar cystic lesion in the sellar/suprasellar region.
DDx: Craniopharyngioma, arachnoid cyst and epidermoid.
Echinococcal parasitic cysts have also been identified in this location.
Can you identify any additional cystic lesions? (Hint: look at the
coronal view).
•Neurocysticercosis is a parasitic disease caused by Taenia solium
•Main cause of acquired epilepsy in developing countries.
•Stages: Inflammatory reaction, gliosis and calcification of the nodule.
•Cystic, racemose or mixed forms.
•
•Racemose form: Basilar cisterns, “cluster of grapes” appearance.
•Hydrocephalus.
Case 2
21 yo male with history of seizures
STOP Proceed to next slides for diagnosis
Band Heterotopia
Finding: There are bilateral bands of grey matter
within the white matter, between the epenyma
and the cortex.
Abnormal migration of gray matter during brain
development.
No enhancement with contrast
Glucose uptake on PET is similar to normal
cortex.
Developmental delay and intractable seizures in
a child.
Companion Case: Nodular Heterotopia
Subependymal type shows nodules, isointense and non-enhancing
to gray matter, along lateral ventricle
DDx: TS, however these calcify and do not follow gray matter
Associated with many other congenital abnormalites, such as chiari
and other migrational disorders
Case 3
65yo female with hearing loss
and dizziness
STOP Proceed to next slide for diagnosis
Superficial Siderosis
Findings: Axial MR T2W (left) and T2 FLAIR images (middle, right)
show subtle dark outlines around the brainstem and in the medial
cerebellar hemispheres consistent with hemosiderin deposition
secondary to chronic recurrent hemorrhages.
Key Facts:
•Source of bleeding often not evident
•Hemosiderin deposition in the subpial layers of brain and spine
•Adult onset slowly progrssive gait ataxia
•Sensineural hearing impairment
•Surgical treatment depends on identification of a bleeding source
Kumar N. Neuroimaging in Superficial
Siderosis: An In-Depth Look, AJNR 2010
31: 5-14
Case 4
31 yo male with 5 mo history of
progressive numbness and tingling in
left hand
STOP Proceed to next slide for diagnosis
Schwanomma with Central Necrosis
Findings: Sagittal T1W, T2W and T1W post gadolinium show a welldefined intrathecal extramedullary mass, compressing the cord
anteriorly, extending from the C2-C3 through the C4-C5 levels. It has a
characteristic meniscus sign.
Key Facts:
•Focal proliferation of Schwann cells
•Intradural extramedullary
•Differential includes meningioma, drop mets
•Peripheral contract enhancement should suggest the diagnosis
Reference: Friedman DP, Tartaglino LM, Flanders AE. Intradural
schwannomas of the spine: MR findings with emphasis on contrastenhancement characteristics. AJR 1992 Jun; 158 (6) : 1347-50
Case 5
61 yo male with multiple right sided
cranial nerve palsies
Case courtesy of Michael Lev, MD
Massachusetts Eye and Ear Hospital
STOP Proceed to next slide for diagnosis
Giant Petrous Apex Aneurysm
• Pulsatile tinnitus, sensorineural hearing
loss.
• May be congenital or acquired.
• Possible wall calcifications and
thrombosis
• Enhancement of mass in petrous ICA.
• MR: Complex signal on T1WI and T2WI
due to flow void and thrombus.
• Treatment: Endovascular
Petrous carotid aneurysm can
mimic a cholesterol cyst on CT.
However this is a Do Not Touch
Lesion !