Download Objectives

MedNeuro Neuroimaging Lab
Mary Kate Worden, Ph.D., Dept of Neuroscience
and Myla Goldman, M.D., Dept of Neurology
Objectives:
1.
To review the planes of section and the appearance
of the CNS and PNS in different imaging modalities.
2.
To identify normal and abnormal structures in
neuroradiographic images.
3.
To predict how neural lesions can give rise to
symptoms in patients.
Slide 1
Q1. Identify the imaging modality, orientation and plane of section for these images.
Q2. One of these patients has motor weakness and the other has sensory deficits.
Identify the abnormalities in these images and explain the symptoms.
A.
QuickTime™ and a
TIFF (LZW) decompressor
are needed to see this picture.
B.
QuickTime™ and a
TIFF (LZW) decompressor
are needed to see this picture.
Slide 2
Q3.Identify the internal carotid angiogram and the vertebral artery angiogram.
Q4. Identify PCA, ACA, vertebral arteries, internal carotid, superior cerebellar
artery, cortical branches of MCA, PCA, lenticulostriate arteries, ophthalmic artery,
basilar artery, posterior communicating artery, insular branches of MCA, and PICA.
(Hint: at least one artery listed cannot be seen. Why not?)
Slide 3
Case study
A ten year old girl with a history of minimal health
care presents with low back pain, increased lower
extremity weakness, and incidence of bladder
incontinence.
Patient’s
lower back
Her neural shows decreased function in her dorsal
and plantal flexors bilaterally, decreased function of
the left quadraceps femoris musculature, decreased
reflexes (pateller and ankle) and sensory deficit
(decreased sensation to pin prick) of the left L5
dermatome. She also has focal hirsutism of the lower
back (indicated by arrow on image).
You send her to radiology (next slide).
Slide 4
Patient
Q5. Identify the imaging
modality, the orientation and the
plane of section.
Normal
Q6. Identify the structure
indicated by the arrows.
Slide 5
Patient
Normal
L5
Q7. Identify the modality of imaging, the orientiation and the plane of section.
What does the arrow point to in the image of the patient?
Q8. Identify the level of the conus medullaris in the patient and in the normal
image. At what level is a lumbar puncture performed?
Slide 6
Neuroradiographs from this patient: .
Q9. What do you think caused the abnormalities you see in
these images from this patient?
Q10. Explain why the clinicians who treated this patient
described her spinal cord as “tethered”.
Q11. How do these images explain her symptoms?
Slide 7
Q12. Identify the imaging modality and plane of section.
Q13. Which image is superior to the other?
QuickTime™ and a
TIFF (Uncompressed) decompressor
are needed to see this picture.
Q14. Identify the lesion and the arterial territory in which it is located.
Q15. Identify the cerebral peduncles, the third ventricle and the
lateral fissure.
Slide 8
QuickTime™ and a
TIFF (Uncompressed) decompressor
are needed to see this picture.
Q16. Which of the following functions do you suspect might be impaired
in this patient? Explain.
sensory (if so, where?)
vestibular function
motor function (if so, where?)
language
Slide 9
Authors of a study of schizophrenic patients measured the
“gyrification index” in each patient as the ratio of length of the inner
cortical contour to the length of the outer cortical contour.
QuickTime™ and a
TIFF (LZW) decompressor
are needed to see this picture.
Q17. What is the imaging modality and orientation?
Q18. Which side of the brain did they measure in these images?
Q19. Identify the internal capsule. What is the internal capsule
composed of?
Slide 10
Authors of a study of schizophrenic patients measured the
“gyrification index” in each patient as the ratio of length of the inner
cortical contour to the length of the outer cortical contour.
QuickTime™ and a
TIFF (LZW) decompressor
are needed to see this picture.
Q20. What lobe(s) of the brain are measured in the anterior segment
image? In the posterior segment image?
Q21. What would you estimate the “gyrification index” to be in these
images?
Slide 11
The authors of this study reported that schizophrenics have a lower
gyrification index than normal patients.
Sallet et al (2003) Am J Psychiatry 160:1606-1613, Reduced cortical folding in
schizophrenics: An MRI morphometric study
Q22. Do you think that the degree of structural abnormality might
correlate with the degree of symptoms in these patients? Why or
why not?
QuickTime™ and a
TIFF (LZW) decompressor
are needed to see this picture.
Q23. What do you think caused the the structural abnormalities
reported by these authors?
Slide 12
Q24. Name the orientation and imaging modality of these sections.
Q25. Can you identify structure indicated by the arrows?
Slide 13
In the images below the foramen magnum is outlined in red.
Q26. Which is normal and which is the patient? How did you
decide?
Q27. Identify the vertebral arteries in both images.
Slide 14
Q28. Identify the following cisterns: cisterna magna,
interpeduncular cistern, pontine cistern, chiasmatic cistern,
superior cistern.
Q29. Name some pathalogical processes that might cause one
or more of the cisterns to change shape.
Slide 15