Neuro-radiology findings

Question 1

Hyper-intensity in lateral putamen on T2-weighted imaging

Answer 1

Multiple system atrophy

Question 2

Diffuse white matter periventricular lesions in 40 year old with migraines with auras, stroke like episodes and family history of migraines and dementia

Answer 2

CADASIL

Question 3

Headache, diplopia, seizures, hemiparesis. CT brain shows no infarction or haemorrhage but shows an ‘empty delta’ sign

Answer 3

Sagittal sinus thrombosis

Question 4

70 year old man with progressive slowing of movement, frequent falls, restriction of upward gaze, slowing and slurring of speech and difficulty swallowing.
a) Diagnosis
b) Characteristic appearances on MRI Brain - sagittal vs axial

Answer 4

a) PSP

b) Sagittal - hummingbird appearance
Axial - mickey mouse midbrain

Both are due to atrophy of the midbrain (as midbrain is responsible for vertical gaze)

Question 5

65 year old female presents with recurrent falls, slowing of movement, symmetrical tremor, and urinary incontinence. Marked truncal ataxia with postural drop on standing.
a) Diagnosis
b) Characteristic appearance on MRI Brain

Answer 5

a) MSA

b) Hot cross bun sign (Pons)*
- Degeneration of pontocerebellar tracts in the pons leads to appearance of hot cross bun on axial view

*May also be seen in spinocerebellar ataxia, or vCJD

Question 6

70 year old lady with headache and seizure following recent trip to China. CT scan shows multiple small high density lesions in the brain.

Answer 6

Neurocysticercosis (from taenia solium parasite - tapeworm from undercooked pork)

Stool culture x3 for ova, cysts and parasites
Pre-load with steroids to reduce ICP
Then 2-3 days later treat with albendazole
Long-term anticonvulsants (largest cause of epilepsy worldwide)