Posts Categorized: Brain

Be sure to make the right differential considerations in this brain case

This 43-year-old female presents with neck pain. Try to work through the case looking at just the first four images, before looking at the same images with arrows indicating key findings. Q1 – The differential diagnosis includes all of the following, except: (a) Glomus (b) Meningioma (c) Epidermoid (d) Schwannoma   A1 – (c) Epidermoid… Read more »

Simple follow-up or important finding?

This 38-year-old male had a seizure 22 years ago. This is a follow-up scan, and the patient has no recent seizures or head trauma. See what you can discern from the first two images before looking at the duplicate images 3 and 4 (with highlighted area on image 4). Q1 – The finding represents: (a)… Read more »

Why are there still problems post-Chiari decompression?

This 40-year-old female presents with Chiari malformation post decompression with occipital headaches. Why are there still problems? In this instance the foramen magnum has been decompressed. Focus on the first two images, then look at duplicates of the same images with arrows indicating key findings.   Causes for failure of Chiari decompression can include inadequate… Read more »

How can you help the surgeon decide how to approach this ACom aneurysm?

This 74-year-old female has been referred for MRI after having difficulty walking with occasional dizziness and a sense of falling. She has been diagnosed with an anterior communicating artery (ACom) aneurysm. As a midline lesion, an ACom aneurysm could theoretically be approached from either side. The better side of the surgical approach depends on a… Read more »

What does this 17-year-old’s brain tell us about why she stopped menstruating?

This 17-year-old female presents with secondary amenorrhea. You are shown two sagittal and three coronal images. What are the causes of pituitary gland enlargement other than a tumor? Which tumor causes infertility and dysmenorrhea or galactorrhea? Could this pituitary hypertrophy be in any way related to amenorrhea? What does the arrow on image 5 indicate?… Read more »

How can we explain this boy’s developmental delay?

This seven-year-old boy presents with autistic disorder, global developmental delay and short stature. What do we see on his imaging that can help provide some answers for him and his family amid these ongoing challenges? This case can initially seem like a stumper. We know this is a boy with developmental delay and short stature,… Read more »

Why isn’t this patient in a coma despite suggestive findings?

This 60-year-old male reports sixth nerve palsy and double vision following a motorcycle accident. You are shown a T2 FLAIR (normal) and a T2* GRE. All other sequences were unremarkable, but the blue arrows on the T2* demonstrate a symmetric deep pattern of hypointensity. Usually, people with siderotic linear signal deep within the brain from… Read more »

Can you help this patient with headaches of unknown origin?

This 53-year-old woman presents with non-intractable headache with unspecified chronicity pattern and unspecified headache type. Patient states no known injury, with pain at the base of head and across the forehead when bending or rotating her head for three months. She is pre-diabetic with no cancer or surgery. What diagnosis is suggested by this history… Read more »

Do you know the extremely rare condition in this brain?

This 42-year-old woman’s brain is affected by a very rare condition. Are you familiar with it?   The rare diagnosis in this case is lipoid proteinosis, also known as Urbach-Wiethe disease or hyalinosis cutis et mucosae. This is an exceedingly rare condition with only several hundred cases known around the world. It results from the… Read more »

Can you diagnose this toddler’s neuro malformation from these three images?

You are shown two raw data images from an MRA/MRV and a sagittal thin-section T2 image. What is the diagnosis (arrows), what is the most likely blood supply, and which vein is persistently dilated as a result of this entity? The findings are consistent with a vein of Galen (arrow) malformation (VOGM). The feeders are… Read more »