Posts Categorized: Neuro

What is causing sudden right-side blindness in this 10-year-old girl?

This 10-year-old female has a history of systemic lupus erythematosus and has suddenly developed right-side blindness. She is dealing with an undiagnosed clinical syndrome, as well as a complication. Identifying both the underlying syndrome and its complication will be critical to the treatment plan. Answer: She is dealing with an intracranial hemorrhage as a complication… Read more »

Which rare congenital disorder is afflicting this three-year-old?

This three-year-old female with multiple congenital hairy nevi syndrome presents with speech difficulty and right hemiparesis. Which rare congenital disorder does she have, and what more common findings is this condition known to mimic? The first image shown is an axial T1 post-contrast with ill-defined meningeal enhancement (pink arrow), while images two and three are… Read more »

What is this infant’s diagnosis after suspected Zika exposure?

This 3-month-old is suspected to have had Zika and toxoplasmosis exposure during pregnancy. Given these factors, and based on the four MRI images and one CT image (bottom) shown, what is her current diagnosis? Are there notable components of the brain that have been spared? The sequela to this Zika/toxoplasmosis exposure is diffuse cortical dysplasia… Read more »

What should you do with this tricky skull base case?

This 59-year-old woman presents with “fluid behind the ear and ear pain’” for months. Lots of physicians try to pass off a skull base middle ear case to another doctor in their group, but we seek to change that. In image one, the three arrows on the left identify what three regions of the middle… Read more »

What are the best MRI next steps for a stroke patient?

This 69-year-old male presents with visual deficit. The finding on CT is a left occipital stroke. In what vascular territory is it distributed? Would the MRI be positive? More specifically, would a FLAIR MRI be positive? What about a diffusion MRI? The location of the stroke is the left posterior cerebral artery territory. FLAIR MRI… Read more »

Lumps have returned for this Sjogren’s patient

This 66-year-old woman presents with parotid adenoma and Sjogren’s syndrome. History of fibroid removal surgery. Patient states she was diagnosed with Sjogren’s syndrome 12 years ago, and complains of lumps on the left side of her neck for 7-8 years, that went away and have come back in the last two months, with more lumps… Read more »

What is the cause of this patient’s droopy eye?

This 55-year-old female presents with a droopy eye, which isn’t something to be taken lightly. In this particular case, the droopy eye is symptomatic of a syndrome with a name you might remember.   Remember Horner’s syndrome, i.e. ptosis meiosis anhydrosis? Here is the classic cause, carotid dissection, with a meniscal curvilinear appearance of the… Read more »

ADEM or MS? How to differentiate between two favored diagnoses

This 15-year-old presents with blurred vision and white-matter lesions on axial FLAIR MRI. Acute disseminated encephalomyelitis (ADEM) and multiple sclerosis (MS) are the two favored diagnoses, so what questions would you ask to differentiate? You should ask: How long has this symptom been present? Is it clinically monophasic or polyphasic? Was there a recent upper… Read more »

Ten-Year-Old With Hearing Loss: What Are The Tipoffs?

10-year-old male with bilateral hearing loss and a bout of meningitis. You are shown one sagittal CT reconstruction. What is the diagnosis? What are some clinical tipoffs? Be sure to think about your answer, then scroll below to see mine. Cystic cochleovestibular anomaly. Clinical tipoffs – Congenital deafness plus recurrent bacterial meningitis. ProScan Pearl: Remember… Read more »

A subependymoma that’s easy to miss

This 37-year-old female presents with a 4th ventricle subependymoma. You could sure miss this!   The inferior 4th ventricle is the most common location followed by the lateral ventricle (over 90 percent are in 4th or lateral). They may not enhance, but the 4th ventricular ones are more likely to, as seen in this case…. Read more »