Neuro Flashcards
Multiple sclerosis
- FINDINGS
There are Multiple high T2 signal lesions
- Perpendicular to the long axis of the lateral ventricle
- Within the sub-cortical white matter- U-fibres.
- Within the lobar gyri
- Within the white matter of the cerebellum
- Within the upper cervical spine
- Lesions are within a peri-ventricular, supratentorial, infratentorial and spinal location)
- NO MASS EFFECT
- There are no T1 lesions.
- There are contrast enhancing areas in some of the previously identified T2 areas.
- Minor diffusion restriction.
- Compare with previous imaging- change in space and time. ( new lesion in 2 compartments or newT2-hyperintense or gadolinium-enhancing lesion in comparison with the baseline.)
- Atrophy of the brain.
DIAGNOSIS
- Multiple sclerosis with new lesions.
- Complicated by treatment- progressive multifocal leukoencephaly.
DIFFERENTIAL
ADEM
MANAGEMENT
- Primary referral- Neurologist- advise on new lesions.
- Secondary referral- Neurology MDT
- Investigations- JC viral load.
- Therapy- immunomodulation.
- Radiological investigation- MRI brain in 6/12.
Ependymoma
Findings
- Abnormality within the upper cervical cord.
- It is intradural, intramedullary.
- It extends from C2-C6 and is 15 cm long.
- It is located within the centre of the spinal cord.
- It is heterogenous T2 signal, low T1 signal.
- It demonstrates contrast enhancement.
- At the superior aspect there is low T2 signal- haemosiderin staining.
- At the inferior aspect there is high T1 signal- haemorrhage.
- There is linear high T2 signal at the superior and the inferior aspect of the spinal canal, parallel to the long axis of the spinal cord- in keeping with a syrinx.
- No further lesion identified.
- Mild expansions and posterior vertebral scalloping at the posterior aspect of the cervical vertebrae.
- Normal signal within the intervertebral discs , vertebral bodies and the imaged brain.
- Degenerative change at C3-C4 and C5-C6.
- Diagnosis
- Spinal cord intra-medullary ependymoma.
- Differential
- Astrocytoma.
- Haemangioblastoma.
- Management
- Referral to neurosurgery.
- Referral to neurosurgical mdt
- Full imaging of the spinal cord and the brain to look for further lesions.
Carotid body paraganglioma
There is a mass with well defined borders in between the external and internal carotid arteries.
It splays the internal and external carotid arteries.
It encases the right internal carotid >180 degrees.
It demonstrates avid contrast enhancement.
Flow voids are present.
There is no internal calcification.
There are flow voids internally.
There is no ipsilateral or contralateral lymphadenopathy.
There is no contralateral mass.
There is no deviation of the tongue or compression/ effacement of the pharynyx ( airway compromise)
Diagnosis-
Carotid paragangilioma
Differential-
- Carotid body schwannoma
- Glomus vagale paragangiolma
Management
- Referral to ENT and ENT MDT for discussion.
- Genetics testing
- MIBG
Raised pressure
- Flattening of the optic disc
- Thickening of the optic sheath posterior to the globe
- Flattening of the posterior sclera
- Kinking of the optic nerve
Pontine Cavernous Haemangioma
Hypertrophic Olivary Degeneration
- Solitary hyper-attenuating 1.5cm mass in the dorsal pons – right of midline
- Minor effacement / distortion / compression of the 4th ventricle – no hydrocephalus
- No appreciable enhancement.
- No definite calcification
- No obvious associated vascular pedicles/structure
Brain MRI
- Some years later – allowing for technical differences no change in size: non ”aggressive”
- Mixed signal lesion (popcorn like) – T1 and T2: high central and peripheral low signal
- Susceptibility/haemorrhagic signal: blooming characteristics – but no frank haematoma
- No obvious associated vascular pedicles
- Increased size and T2 signal – right inferior olivary nucleus
- Deviated globe with atrophic lateral rectus on the right, Small vessel ischaemic disease
Differential
- Telangectasia
- aneurysm
- tumour (low grade, haemorragic)
