Teaching NeuroImages Adam Ostendorf, MD, Robert C. McKinstry, MD, PhD, Joshua S. Shimony, MD, PhD, David H. Gutmann, MD, PhD.

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Teaching NeuroImages Adam Ostendorf, MD, Robert C. McKinstry, MD, PhD, Joshua S. Shimony, MD, PhD, David H. Gutmann, MD, PhD

Vignette 4-year-old boy with neurofibromatosis type 1 (NF1), an asymptomatic optic glioma, and a right basal ganglia T2-hyperintense lesion Motor exam was unremarkable at age 9 Exam at age 14 reveals a mild left hemiparesis with hyperreflexia, which the family noticed over the past year when he was running Ostendorf et al

Brain MRI Ostendorf et al Brain Magnetic Resonance Imaging (MRI) from 2003 revealed a T2-hyperintensity in the right basal ganglia frequently observed in children with NF1. In 2012, a cyst-like mass was found in the identical location associated with a new left hemiparesis and hyperreflexia. (A, C) represent fluid attenuated inversion recovery (FLAIR) images while (B, D) are T1-weighted images. Ostendorf et al

T2-Hyperintensities in Neurofibromatosis Type 1 (NF1) It is often difficult to distinguish T2-hyperintensities from low-grade glioma without tissue diagnosis, even with advanced imaging methods T2-hyperintensities typically disappear with age and do not become cystic with associated mass effect Coupled with the development of new neurological signs, these MRI features are worrisome for neoplasm in a patient with NF1. References DeBella K, Poskitt K, Szudek J, Friedman JM. Neurology 2000;54(8):1646-1651. Ferraz-Filho JR, da Rocha AJ, Muniz MP, Souza AS, Goloni-Bertollo EM, Pavarino-Bertelli EC. Pediatr Radiol 2012;42(4):449-454. Ostendorf et al