Radcases Neuro Imaging (Radcases Plus Q&A)

225 Pages·2010·13.301 MB·English

by  Roy F. Riascos-Castaneda (editor), Eliana Bonfante (editor)

Neuro Imaging
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Neuro Imaging
Edited by
Roy Riascos, MD
Associate Professor of Radiology
Department of Radiology
The University of Texas Medical Branch
Galveston, Texas
Eliana Bonfante, MD
Assistant Professor
Department of Diagnostic and Interventional Imaging
University of Texas Medical School at Houston
Houston, Texas
Series Editors
Jonathan Lorenz, MD
Associate Professor of Radiology
Department of Radiology
The University of Chicago
Chicago, Illinois
Hector Ferral, MD
Professor of Radiology
Section Chief, Interventional Radiology
RUSH University Medical Center, Chicago
Chicago, Illinois
Thieme
New York • Stuttgart
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Thieme Medical Publishers, Inc.
333 Seventh Ave.
New York, NY 10001
Executive Editor: Timothy Hiscock
Editorial Assistant: Adriana di Giorgio
Editorial Director: Michael Wachinger
Production Editor: Katy Whipple, Maryland Composition
International Production Director: Andreas Schabert
Vice President, International Marketing and Sales: Cornelia Schulze
Chief Financial Offi cer: James W. Mitos
President: Brian D. Scanlan
Compositor: MPS Content Services
Printer: Sheridan Press
Library of Congress Cataloging-in-Publication Data
Neuro imaging / edited by Roy F. Riascos and Eliana E. Bonfante.
p. ; cm. — (RadCases)
Includes bibliographical references.
Summary: This book is not intended to teach neuroradiology—it is only a review of the most frequent patholo-
gies and serves as a tool to be able to tell them apart. Of course, telling them apart is not always possible, and
that is the whole trick of giving a pertinent set of diff erential diagnoses and trying to favor one over the other.
Our advice is to always look at the fi rst image and try to describe as much as you can, as if it was the only image
you had available, then go through the rest of the images and see if the thought process was similar. It would be
impossible to include all the pertinent diff erential diagnoses for each case with the format limitation of three
diff erential diagnoses per case. This way of teaching imaging analysis can both be similar to and very diff erent
from your daily clinical practice. Often, the pertinent fi nding or telltale sign to achieve a diagnosis lies in just a
few of the images within an entire examination; however, you have to see the entire case and fi nd these. Here,
images that have been deemed key by someone else are selected, giving you the advantage of a focused search
but the limitation of a narrow representation. You may fi nd yourself frustrated by off ering a totally diff erent
diff erential diagnosis from the one presented to you here, but be aware that the same case can have a com-
pletely diff erent approach based on the way it is presented, the order of the images, or the fi nding in which you
are focusing your process of thought. Additional references are provided to help you widen the scope of your
review, especially in subjects that you may fi nd more challenging or controversial—Provided by publisher.
ISBN 978-1-60406-189-5
1. Nervous system—Radiography—Case studies. I. Riascos, Roy F. II. Bonfante, Eliana E. III. Series: RadCases.
[DNLM: 1. Central Nervous System Diseases—radiography—Case Reports. 2. Central Nervous System—
radiography—Case Reports. 3. Diagnostic Techniques, Neurological—Case Reports. WL 141 N4825 2010]
RC349.R3N33 2010
616.8’047572―dc22
2010020830

Copyright © 2011 by Thieme Medical Publishers, Inc. This book, including all parts thereof, is legally pro-
tected by copyright. Any use, exploitation, or commercialization outside the narrow limits set by copyright
legislation without the publisher’s consent is illegal and liable to prosecution. This applies in particular to
photostat reproduction, copying, mimeographing or duplication of any kind, translating, preparation of mi-
crofi lms, and electronic data processing and storage.
Important note: Medical knowledge is ever-changing. As new research and clinical experience broaden our
knowledge, changes in treatment and drug therapy may be required. The authors and editors of the material
herein have consulted sources believed to be reliable in their eff orts to provide information that is complete
and in accord with the standards accepted at the time of publication. However, in view of the possibility of
human error by the authors, editors, or publisher of the work herein or changes in medical knowledge, nei-
ther the authors, editors, nor publisher, nor any other party who has been involved in the preparation of this
work, warrants that the information contained herein is in every respect accurate or complete, and they are
not responsible for any errors or omissions or for the results obtained from use of such information. Readers
are encouraged to confi rm the information contained herein with other sources. For example, readers are
advised to check the product information sheet included in the package of each drug they plan to administer
to be certain that the information contained in this publication is accurate and that changes have not been
made in the recommended dose or in the contraindications for administration. This recommendation is of
particular importance in connection with new or infrequently used drugs.
Some of the product names, patents, and registered designs referred to in this book are in fact registered
trademarks or proprietary names even though specifi c reference to this fact is not always made in the text.
Therefore, the appearance of a name without designation as proprietary is not to be construed as a represen-
tation by the publisher that it is in the public domain.
Printed in the United States
978-1-60406-189-5
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To the woman for whom my heart surrenders, Maria Claudia, and our three sons,
Camilo, Felipe, and Pablo, for making my life this wonderful experience.
—Roy Riascos
This book is dedicated to my loving and supporting soulmate, Darren,
and to our two wonderful and inspiring children, Matthew and Zachary.
—Eliana Bonfante
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RadCases Series Preface
The ability to assimilate detailed information across the en- view books, we removed the guesswork by providing clear
tire spectrum of radiology is the Holy Grail sought by those annotations and descriptions for all images. In our opinion,
preparing for the American Board of Radiology examination. there is nothing worse than being unable to locate a subtle
As enthusiastic partners in the Thieme RadCases Series who fi nding on a poorly reproduced image even after one knows
formerly took the examination, we understand the exhaus- the fi nal diagnosis.
tion and frustration shared by residents and the families of The electronic cases expand on the printed book and
residents engaged in this quest. It has been our observation provide a comprehensive review of the entire subspecialty.
that despite ongoing eff orts to improve Web-based interac- Thousands of cases are strategically designed to increase the
tive databases, residents still fi nd themselves searching for resident’s knowledge by providing exposure to additional
material they can review while preparing for the radiology case examples—from basic to advanced—and by exploring
board examinations and remain frustrated by the fact that “Aunt Minnie’s,” unusual diagnoses, and variability within
only a few printed guidebooks are available, which are lim- a single diagnosis. The search engine gives the resident a
ited in both format and image quality. Perhaps their greatest fi ghting chance to fi nd the Holy Grail by creating individual-
source of frustration is the inability to easily locate groups of ized, daily study lists that are not limited by factors such as a
cases across all subspecialties of radiology that are organized radiology subsection. For example, tailor today’s study list to
and tailored for their immediate study needs. Imagine being cases involving tuberculosis and include cases in every sub-
able to immediately access groups of high-quality cases to specialty and every system of the body. Or study only tho-
arrange study sessions, quickly extract and master informa- racic cases, including those with links to cardiology, nuclear
tion, and prepare for theme-based radiology conferences. medicine, and pediatrics. Or study only musculoskeletal
Our goal in creating the RadCases Series was to combine the cases. The choice is yours.
popularity and portability of printed books with the adapt- As enthusiastic partners in this project, we started small
ability, exceptional quality, and interactive features of an and, with the encouragement, talent, and guidance of Tim
electronic case-based format. Hiscock at Thieme, continued to raise the bar in our eff ort
The intent of the printed book is to encourage repeated to assist residents in tackling the daunting task of assimi-
priming in the use of critical information by providing a por- lating massive amounts of information. We are passionate
table group of exceptional core cases that the resident can about continuing this journey, hoping to expand the cases in
master. The best way to determine the format for these cases our electronic series, adapt cases based on direct feedback
was to ask residents from around the country to weigh in. from residents, and increase the features intended for board
Overwhelmingly, the residents said that they would prefer review and self-assessment. As the American Board of Radi-
a concise, point-by-point presentation of the Essential Facts ology converts its certifying examinations to an electronic
of each case in an easy-to-read, bulleted format. This ap- format, our series will be the one best suited to meet the
proach is easy on exhausted eyes and provides a quick re- needs of the next generation of overworked and exhausted
view of Pearls and Pitfalls as information is absorbed during residents in radiology.
repeated study sessions. We worked hard to choose cases
that could be presented well in this format, recognizing the Jonathan Lorenz, MD
limitations inherent in reproducing high-quality images in Hector Ferral, MD
print. Unlike the authors of other case-based radiology re- Chicago, IL
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Preface
This book is not intended to teach neuroradiology—it is only however, you have to see the entire case and fi nd these. Here,
a review of the most frequent pathologies and serves as a images that have been deemed key by someone else are se-
tool to be able to tell them apart. Of course, telling them lected, giving you the advantage of a focused search but the
apart is not always possible, and that is the whole trick of limitation of a narrow representation. You may fi nd yourself
giving a pertinent set of diff erential diagnoses and trying to frustrated by off ering a totally diff erent diff erential diagno-
favor one over the other. Our advice is to always look at the sis from the one presented to you here, but be aware that the
fi rst image and try to describe as much as you can, as if it was same case can have a completely diff erent approach based
the only image you had available, then go through the rest on the way it is presented, the order of the images, or the
of the images and see if the thought process was similar. It fi nding in which you are focusing your process of thought.
would be impossible to include all the pertinent diff erential Additional references are provided to help you widen the
diagnoses for each case with the format limitation of three scope of your review, especially in subjects that you may fi nd
diff erential diagnoses per case. more challenging or controversial.
This way of teaching imaging analysis can both be similar We hope that with the interactive nature of this publi-
to and very diff erent from your daily clinical practice. Often, cation, you will have the chance to give us some feedback
the pertinent fi nding or telltale sign to achieve a diagnosis and help us improve and update this material on a frequent
lies in just a few of the images within an entire examination; basis.
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