Brain Imaging Case Review Series

309 Pages·2011·203.387 MB·English

by  Ankur Arora, Sunil Kumar Puri, Lalendra Upreti

BRAIN IMAGING
Case Review Series

BRAIN IMAGING
Case Review Series
Ankur Arora
MD DNB FRCR(UK)
Assistant Professor
Department of Radiodiagnosis
Institute of Liver and Biliary Sciences (ILBS)
An Autonomous Institute under Government of NCT of Delhi
New Delhi, India
Sunil Kumar Puri
MD
Director-Professor and Head
Department of Radiodiagnosis
GB Pant Hospital and associated Maulana Azad Medical College
New Delhi, India
Lalendra Upreti
MD DNB
Professor
Department of Radiodiagnosis
GB Pant Hospital and associated Maulana Azad Medical College
New Delhi, India
®
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Brain Imaging: Case Review Series
© 2011, Jaypee Brothers Medical Publishers
All rights reserved. No part of this publication should be reproduced, stored in a retrieval system, or transmitted in any form or
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First Edition: 2011
ISBN 978-93-5025-389-2
Typeset at JPBMP typesetting unit
Printed in India
Preface
The intent of this book is to provide 150 need-to-know neuroradiological diagnoses in Brain Imaging for the
radiology residents, neuroradiology fellows and practicing radiologists. The book is ideal for those who are preparing
for their MD, DMRD, DNB and FRCR examinations. The format simulates the way radiology residents are
generally taught. The teaching of radiology residents is typically performed using the ‘case discussion technique’
wherein the resident is usually unaware of the diagnosis and is presented with specific images and allied clinical
details. The discussant is required to determine pertinent imaging findings and generate a reasonable differential
diagnoses based on the imaging findings and relevant clinical history, and, by the process of elimination, decide on
the most likely diagnosis. A similar ‘case discussion format’ has been adopted in this book, providing the readers
with images from the latest available imaging modalities and covering all major diseases that are encountered in
everyday clinical practice. In reading each case, the reader should direct attention to the clinical history and provided
radiological images. After arriving at a diagnosis, the reader should then flip the page for the correct diagnosis as
well as the supplementary commentary on each case. An attempt has been made to answer almost all frequently
asked questions in the radiological examinations. The commentary although not all-encompassing serves as a
fundamental framework on which one can add information from more comprehensive texts. Each case is followed
by distinct learning points and the best-diagnostic-clue, so as to provide novice as well as experienced readers a
brief but succinct summary of the particular disease entity. A concise list of particularly relevant references has also
been provided. Purposely, the cases are randomly assorted and not organized by disease-type into congenital,
infective or neoplastic entities so as to provide the readers with a realistic examination scenario. The cases (in the
textbook) based upon the varying difficulty levels have been categorized into Basic, Intermediate and Advanced
(50 cases in each). This richly illustrated series contains cases that are a compilation of illustrative teaching material
collected over past several years and the authors sincerely hope that the readers will find this book enormously
useful. The readers’ comments and questions are heartily welcomed.
Ankur Arora
Sunil Kumar Puri
Lalendra Upreti

Acknowledgments
We are indebted to Dr SK Sarin, Director, Institute of Liver and Biliary Sciences (ILBS), New Delhi, India. He has
been a constant source of inspiration, encouragement and a guiding force.
We are grateful to Dr Veena Choudhary, Director, GB Pant Hospital, New Delhi, India for her valuable guidance
and support in completing this book.
We wish to express our gratitude to Dr Satbir Singh, Professor, GB Pant Hospital, New Delhi, India whose
constant motivation and encouragement were of tremendous help. We also acknowledge Dr Ashok Sharma and
Dr Poonam Narang for their valuable inputs.
Many of the cases in this book are obtained from Mahajan Imaging Center, and we are much indebted to
Dr Harsh Mahajan (Padma Shree, Honorary Radiologist to the President of India) for heartily sharing these cases.
We are thankful to Prof Hans L Bloem, Editor-in-Chief, EURORAD (the largest peer-reviewed teaching database
of the European Society of Radiology on the Internet), for permitting us to duplicate several cases published by us
at the EURORAD.
We are grateful to Dr VRK Rao, Professor and Head, Department of Radiodiagnosis, Kasturba Medical College
(KMC), Manipal, Karnataka, India and one and all of the Radiology departments of Kasturba Medical College
(KMC), Manipal and Mangalore, Karnataka, India for their unswerving support.
We acknowledge the impetus and constructive feedbacks received from Dr Raghu HR, Pediatric Radiologist,
Arkansas Children’s Hospital, Little Rock, United States; Dr Aravinda KM, Montefiore Medical Center,
New York, United States; Dr Avinash KR and Dr Naveen M Kulkarni, Massachusetts General Hospital, Boston,
United States and Dr Rajiv Gupta, Senior Consultant Radiologist, Medanta-The Medicity, Gurgaon, Haryana,
India.
Our sincere thanks to Dr Ruchi Bhutani, Consultant Radiologist, Fortis La Femme Hospital, New Delhi, India
who has spent many a sleepless nights painstakingly editing the manuscript.
We are also thankful to Dr Abhay Kapoor and Dr Vandana, Senior Residents, GB Pant Hospital, New Delhi,
India and Dr Chandan Kakkar and Dr Ashwin M Polnaya, Assistant Professors, Kasturba Medical College (KMC),
Manipal, Karnataka, India for their assistance in the preparation of the manuscript.
Warm gratitude is due to the non-teaching staff including the technical staff and radiographers of Department
of Radiodiagnosis, GB Pant Hospital, New Delhi, India for their incessant support.
Our earnest thanks to the faculty members and colleagues of various clinical specialties whose patients formed
the framework of this case review series.
Last but not least, we are grateful and appreciative of the support, patience and encouragement extended by
our family members, friends and colleagues.

Contents
BASIC CASES
Case 1: Chiari Malformation-I ...........................................................................................................................1
Case 2: Sturge-Weber Syndrome........................................................................................................................3
Case 3: Hyperostosis Frontalis Interna...............................................................................................................5
Case 4: Eosinophilic Granuloma........................................................................................................................7
Case 5: Tuberous Sclerosis.................................................................................................................................9
Case 6: Giant Aneurysm ..................................................................................................................................11
Case 7: Subdural Hemorrhage (Subacute Stage)..............................................................................................13
Case 8: Cerebral Hydatid Cyst.........................................................................................................................15
Case 9: Acute Infarct........................................................................................................................................17
Case 10: Cavernous Angioma (Cavernoma).....................................................................................................19
Case 11: Intracranial Abscess...........................................................................................................................21
Case 12: Cavum Septum Pellucidum and Cavum Vergae.................................................................................23
Case 13: Sphenoid Wing Dysplasia (NF1) .......................................................................................................25
Case 14: Subacute Infarct ................................................................................................................................27
Case 15: Internal Carotid Artery thrombosis...................................................................................................29
Case 16: Cerebral Hematoma: Early and Late Subacute..................................................................................31
Case 17: Acromegaly .......................................................................................................................................33
Case 18: Calvarial Hemangioma......................................................................................................................35
Case 19: ‘Hyperdense MCA Sign’...................................................................................................................37
Case 20: Corpus Callosum Agenesis................................................................................................................39
Case 21: Hypertensive Basal Ganglia Bleed .....................................................................................................41
Case 22: Subdural and Epidural Empyema......................................................................................................43
Case 23: Multiple Sclerosis..............................................................................................................................45
Case 24: Schizencephaly— Closed Lip..............................................................................................................47
Case 25: Septo-Optic Dysplasia (de Morsier’s Syndrome) ...............................................................................49
Case 26: Subarachnoid Hemorrhage................................................................................................................51
Case 27: Lissencephaly.....................................................................................................................................53
Case 28: Copper Beaten Skull with Craniosynostosis.......................................................................................55
Case 29: Watershed Infarcts.............................................................................................................................57
Case 30: Venous Angioma (Caput Medusae Sign) ...........................................................................................59
Case 31: Superior Sagittal Sinus Thrombosis...................................................................................................61
Case 32: Aqueduct Stenosis.............................................................................................................................63
Case 33: Enlarged Virchow-Robin Spaces.......................................................................................................65
Case 34: Choroid Plexus Cysts........................................................................................................................67
Case 35: Congenital Cytomegalovirus (CMV) Infection .................................................................................69
Case 36: Arachnoid Cyst..................................................................................................................................71
Case 37: Lacunar Skull.....................................................................................................................................73
Case 38: Mycotic Aneurysm ............................................................................................................................75
Case 39: Vascular Loop Syndrome...................................................................................................................77
Case 40: Intracranial Neurocysticercosis..........................................................................................................79
Case 41: Neurofibromatosis Type-II................................................................................................................81
Brain Imaging: Case Review Series
Case 42: White Cerebellum (Reversal) Sign; and Pseudo-Subarachnoid Hemorrhage.....................................83
Case 43: Granulomatous (Tuberculous) Meningitis.........................................................................................85
Case 44: Sphenoid Wing Meningioma.............................................................................................................87
Case 45: Polymicrogyria..................................................................................................................................89
Case 46: Porencephaly.....................................................................................................................................91
Case 47: Colloid Cyst ......................................................................................................................................93
Case 48: Ruptured Intracranial Dermoid with Chemical Meningitis................................................................95
Case 49: Cavernous Carotid Aneurysm ...........................................................................................................97
Case 50: Arnold Chiari-II Malformation .........................................................................................................99
s INTERMEDIATE CASES
t
n
e
t Case 51: Cerebral Arteriovenous Malformation (Spetzler-Martin Grade-4)...................................................101
n
o Case 52: Chiari Malformation Type-III .........................................................................................................103
C
Case 53: Subependymal Grey Matter Heterotopia.........................................................................................105
Case 54: Carotid Cavernous Fistula...............................................................................................................107
Case 55: Central Pontine Myelinolysis...........................................................................................................109
Case 56: Epidermoid Cyst of the Cerebellopontine Angle.............................................................................111
Case 57: von Hippel-Lindau Disease.............................................................................................................113
Case 58: Brainstem Glioma............................................................................................................................115
Case 59: Wallerian Degeneration ...................................................................................................................117
Case 60: Intra-Ventricular Neurocysticercosis................................................................................................119
Case 61: Leptomeningeal Carcinomatosis......................................................................................................121
Case 62: Intracranial Tuberculomas (Caseating with a Solid Center).............................................................123
Case 63: Glioblastoma Multiforme................................................................................................................125
Case 64: Pituitary Macroadenoma.................................................................................................................127
Case 65: Hypertrophic Pachymeningitis........................................................................................................129
Case 66: Anaplastic Astrocytoma...................................................................................................................131
Case 67: Primitive Neuroectodermal Tumor (PNET)....................................................................................133
Case 68: Pilocytic Astrocytoma......................................................................................................................135
Case 69: Subependymal Giant Cell Astrocytoma (SEGA)..............................................................................137
Case 70: Post Meningitic Ventriculitis and Infarcts........................................................................................139
Case 71: Diffuse Axonal Injury (DAI) ...........................................................................................................141
Case 72: Phenytoin Induced Cerebellar Atrophy...........................................................................................143
Case 73: Rathke Cleft Cyst ............................................................................................................................145
Case 74: Trigeminal Schwannoma.................................................................................................................147
Case 75: Sincipital (Frontoethmoidal) Encephalocele....................................................................................149
Case 76: Mesial Temporal Sclerosis................................................................................................................151
Case 77: Tuber Cinereum Hamartoma..........................................................................................................153
Case 78: Focal Cortical Dysplasia of Taylor’s Balloon Cell Type....................................................................155
Case 79: Ependymoma of the Fourth Ventricle.............................................................................................157
Case 80: Medulloblastoma.............................................................................................................................159
Case 81: Vein of Galen Malformation............................................................................................................161
Case 82: Orbital Venous-Lymphatic Malformation........................................................................................163
Case 83: Wallenberg Syndrome.....................................................................................................................165
Case 84: Petrous Apicitis...............................................................................................................................167
Case 85: Multi Infarct Dementia...................................................................................................................169
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