CNS Cases

25

60 year old female headache

Discussion • Findings — Partially calcified cystic lesion— Midline posterior nasopharynx— Located between longus coli muscles • Differential — Tornwaldt cyst— Adenoid hyperplasia— Retention cyst— Nasopharyngeal carcinoma Tornwaldt cyst Benign cyst of notochord remnant Variable protein content->intermediate to high T1 signal High T2 signal Located between longus coli muscles in midline May demonstrate rim enhancemen

19

female with unequal pupils, history of congenital heart disease and endocarditis

  Discussion   Findings – Large acute subdural hematoma– Subarachnoid hemorrhage– Uncal and subfalcine herniation– Lobular contrast collection Differential – Ruptured pseudoaneurysm, likely mycotic– Ruptured aneurysm– Arteriovenous malformation– Trauma– Nonaccidental trauma   Ruptured pseudoaneurysm • Focally dilated arterial segment, not contained by all layers of the arterial wall• Causes– Trauma– Infection (endocarditis in this case)– …

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14

22-year-old male found in ditch mangled

 Discussion Findings — Anterior wedge compression fracture of T6 — Distraction fracture of posterior elements — Splenic laceration and hemoperitoneum Differential — Chance fracture — Burst fracture — Osteoporotic compression fracture — Pathologic compression fracture Chance fracture Flexion-distraction injury, seat-belt fracture Compression injury of anterior column Distraction injury of middle and posterior columns Usually occurs …

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10

50-year-old female

Discussion • Findings – Central pontine enhancing focus – No mass effect • Differential – Capillary telangiectasia – Developmental venous anomaly – Metastasis – Cavernous malformation Brain capillary telangiectasia • Cluster of enlarged capillaries with interspersed parenchyma • Enhancement without mass effect • 50% T2 hyperintense • Common locations -Pons -Cerebellum -Spinal cord

6

A unresponsive 45-year-old male

Discussion Findings – Globus Pallidus • CT hypodense • T2/DWI hyperintense Differential – Carbon monoxide poisoning – Wilson disease – Japanese encephalitis Acute carbon monoxide poisoning Anoxic-ischemic encephalopathy due to inhaled CO Carbon monoxide impairs hemoglobintransport of oxygen Infarct of globi pallidi Restricted diffusion in early/acuteexposure

6 year old female with headach

Findings – Heterogeneous mass– IntrinsicT1 and lowT2 margin– Blooming artifact atGRE Differential – Cavernous malformation– Diffuse axonal injury– Arteriovenous malformation– Hemorrhagic neoplasm Cavernous Malformation Cavernous Malformation = cavernoma, cavernous angioma, cavernous hemangioma Benign sporadic or familial low pressure vascular lesion with bleeding propensity Locules of blood in different phases 50% have calcification show T2* GRE …

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50 year-old female

Findings – Central pontine enhancing focus– No mass effect Differential – Capillary telangiectasia– Developmental venous anomaly– Metastasis– Cavernous malformation Diagnosis: Brain capillary telangiectasia • Cluster of enlarged capillaries with interspersed parenchyma• Enhancement without mass effect• 50% T2 hyperintense• Common locations-Pons-Cerebellum-Spinal cord

A 45-year-old male unresponsive

[td_smart_list_end] Findings – Globus Pallidus• CT hypodense• T2/DWI hyperintense Differential – Carbon monoxide poisoning– Wilson disease– Japanese encephalitis Diagnosis: Acute carbon monoxide poisoning • Anoxic-ischemic encephalopathy due to inhaled CO• Carbon monoxide impairs hemoglobin transport of oxygen• Infarct of globi pallidi• Restricted diffusion in early/acute exposure

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