Teaching NeuroImages Neurology Resident and Fellow Section

Slides:

Advertisements

Similar presentations

A 52-year old man with recently diagnosed HIV infection with irregular shaking of his hand Teaching NeuroImages Neurology Resident and Fellow Section ©

Advertisements

A 62-year-old man presented with mild left hemiparesis, headache and blurred vision of his right eye Teaching NeuroImages Neurology Resident and Fellow.

A 68 year old woman with a troublesome chin tremor Teaching NeuroImages Neurology Resident and Fellow Section © 2013 American Academy of Neurology.

Neurology Resident and Fellow Section 40 year old woman with left arm pain, numbness, and weakness Teaching NeuroImages © 2013 American Academy of Neurology.

Teaching NeuroImages Neurology Resident and Fellow Section © 2014 American Academy of Neurology 46 year-old women with acute headache, post seizure confusion.

A 43-year-old man with decreased consciousness Teaching NeuroImages Neurology Resident and Fellow Section © 2014 American Academy of Neurology.

A 38-year-old patient with partial seizures Teaching NeuroImages Neurology Resident and Fellow Section © 2014 American Academy of Neurology.

A 53-year-old man with abrupt hearing loss Teaching NeuroImages Neurology Resident and Fellow Section © 2013 American Academy of Neurology.

Teaching NeuroImages Neurology Resident and Fellow Section © 2013 American Academy of Neurology A dangerous case of orthostatic headache.

47-year-old with progressive upper limb weakness Teaching NeuroImages Neurology Resident and Fellow Section © 2014 American Academy of Neurology.

Teaching NeuroImages Neurology Resident and Fellow Section © 2013 American Academy of Neurology An unusual cause of conus medullaris syndrome.

A 39-year old man with facial diplegia Teaching NeuroImages Neurology Resident and Fellow Section Campbell J, et al © 2013 American Academy of Neurology.

Teaching NeuroImages Neurology Resident and Fellow Section © 2014 American Academy of Neurology A 23 month old full term male with seizures.

68 year old man with aphasia and facial droop © 2014 American Academy of Neurology Teaching NeuroImages Neurology Resident and Fellow Section.

Progressive fetal intracranial lesion Teaching NeuroImages Neurology Resident and Fellow Section © 2015 American Academy of Neurology.

A 26 year old woman with headache, diplopia, and pulsatile tinnitus Teaching NeuroImages Neurology Resident and Fellow Section © 2013 American Academy.

A 45 year old man with painful right eye blindness Teaching NeuroImages Neurology Resident and Fellow Section © 2013 American Academy of Neurology.

A 4 Year Old Boy With Proptosis of Left Eye Teaching NeuroImages Neurology Resident and Fellow Section © 2014 American Academy of Neurology.

A 50 year-old female with right hemiplegia and encephalopathy

55 year-old man with acute headache and dizziness Teaching NeuroImages Neurology Resident and Fellow Section David Yen-Ting Chen, MD Ying-Chi Tseng, MD.

A 9-year old girl with multi-compartmental intracranial hemorrhage

Neurology Resident and Fellow Section

Rupture and spontaneous resolution of a P1 perforator pseudoaneurysm

68-year-old patient with memory impairment

Figure Brain MRI of the patient throughout the disease course(A) Brain MRI at the time of cerebral toxoplasmosis diagnosis (a) and after 1 month of toxoplasmosis.

Ruptured PICA aneurysm in a 62-year-old man presenting in poor clinical condition. Ruptured PICA aneurysm in a 62-year-old man presenting in poor clinical.

A 49-year-old man presenting with left abducens and right facial nerve palsies. A 49-year-old man presenting with left abducens and right facial nerve.

High-complexity example of Pipeline embolisation device (PED) treatment of a giant 25 mm right-sided petrocavernous internal carotid artery (ICA) cerebral.

Right carotid angiogram (A) demonstrates a small carotid cave aneurysm in a patient who had an anterior communicating artery aneurysm previously treated.

A 48-year-old man who presented with severe sudden headache.

Axial CT scans of the brain and neck performed with contrast medium.

A, Left internal carotid artery (ICA) angiogram showing a left middle cerebral artery (MCA) bifurcation aneurysm and an additional distal MCA aneurysm.B.

A, Axial source image from a contrast-enhanced MRA unambiguously demonstrates a tiny (

Preoperative 3D angiogram (A) shows a very wide-neck large ICA aneurysm. Preoperative 3D angiogram (A) shows a very wide-neck large ICA aneurysm. It could.

20 year old man with multiple strokes territories

A 68-year-old woman presenting 18 days after SAH from PICA aneurysm.

Teaching NeuroImages Neurology Resident and Fellow Section

Pseudoresponse. Pseudoresponse. A 47-year-old man with GBM. A reduction of the enhancing portion of the lesion is observed 1 day after initiation of cediranib.

Patient 9. Patient 9. A 31-year-old man with mental status changes and seizure activity.A, T2-weighted axial MR image shows bilateral frontal and right.

Patient 16 is a 39-year-old woman status post bowel resection and appendectomy for Crohn disease being maintained on antibiotics and steroids with baseline.

Three perfusion sections.

A 2 year old girl with progressive neurological deficits

Endovascular treatment was performed approximately 8 months after the patient’s initial diagnosis. Endovascular treatment was performed approximately 8.

Patient 5. Patient 5. Initial axial, half cut, and magnified MR images of a 39-year-old man with spontaneous intracranial hypotension who presented with.

Patient 6: 24-year-old woman with primary angiitis of the CNS

Case 2.A, Right internal carotid artery (ICA) angiogram, oblique view, showing a 4-mm aneurysm at the right middle cerebral artery (MCA) bifurcation.B,

A 64-year-old man with oculomotor nerve palsy from a partially thrombosed giant cavernous sinus aneurysm. A 64-year-old man with oculomotor nerve palsy.

A 49-year-old man with abducens nerve palsy from a partially thrombosed PICA aneurysm projecting into the brain stem. A 49-year-old man with abducens nerve.

Results of aneurysm treatment with flow modification only.

Teaching NeuroImages Neurology Resident and Fellow Section

Case 2: Agenesis of the left ICA

Endovascular coil occlusion of an enlarging carotid artery pseudoaneurysm. Endovascular coil occlusion of an enlarging carotid artery pseudoaneurysm. Sagittal.

Multiple PCA associated with Moya-Moya disease, successfully treated with GDC. A, Frontal view of left internal carotid angiogram showing occlusion of.

DSA and contrast-enhanced MRA show concordant findings

Patient with a 6-mm aneurysm of the AcomA that was treated with GDCs

62-year-old woman with incidentally discovered bilateral cavernous sinus aneurysms. 62-year-old woman with incidentally discovered bilateral cavernous.

Left carotid artery angiograms demonstrate the persistent otic artery (a), the basilar artery (b), the fetal posterior cerebral artery (PCA) (c), the ACoA.

Giant cavernous carotid aneurysm, with the patient presenting with third and sixth nerve palsy due to mass effect (patient 16, On-line Table and Tables.

A 10-year-old boy with symptoms of brain stem compression from a giant partially thrombosed distal vertebral aneurysm. A 10-year-old boy with symptoms.

A 42-year-old man presenting with progressive deterioration of consciousness. A 42-year-old man presenting with progressive deterioration of consciousness.

A 43-year-old male patient with headaches (case 33).

A 63-year-old female with a giant left internal carotid artery, cavernous segment aneurysm undergoing treatment with PED. Angiography from a catheter positioned.

The patient is a 47-year-old man.

Giant infrasupraclinoid aneurysm of the right ICA

Preprocedural CT and procedural and follow-up angiograms of a 39-year-old female patient with a distal PICA aneurysm. Preprocedural CT and procedural and.

A, 3D volume-rendered reformat of a left ICA rotational angiogram shows a giant distal supraclinoid ICA aneurysm. A, 3D volume-rendered reformat of a left.

Stent placement for treatment of acute intracranial occlusion.

33-year-old African-American woman with right-sided visual loss, panhypopituitarism, polydipsia, and polyuria (with normal ADH). 33-year-old African-American.

Procedural and follow-up angiograms of a 28-year-old female patient with a history of subarachnoid hemorrhage due to rupture of a contralateral MCA bifurcation.

A 71-year-old female with multiple large intracranial aneurysms.

Presentation transcript:

Teaching NeuroImages Neurology Resident and Fellow Section 64-year-old female with paraclinoid aneurysm found after screening by Enrico Giordan, Waleed Brinjikji, Giuseppe Lanzino Teaching NeuroImages Neurology Resident and Fellow Section Giordan et al. © 2013 American Academy of Neurology

Vignette 64-year-old female Paraclinoid aneurysm found during screening for strong family history Endovascular treatment with flow diversion After 2 months she presented with headache and intermittent word finding difficulty Brain MRI demonstrated multiple areas of nodular enhancement ipsilateral to the treated aneurysm After a 6-week course of oral steroids the radiological findings and her symptoms resolved Giordan et al. © 2013 American Academy of Neurology

Imaging Giordan et al. A B C D E Figure 1. Left ICA aneurysm on cerebral angiogram and rationale behind pipeline placement. A. Cerebral angiogram shows a 6-mm periophtalmic left ICA aneurysm. Drawing of flow diversion for intracranial aneurysms. B. Blood flow through an untreated aneurysm. C. Flow diverter placed in the parent vessel redirects blood causing intraaneurysmal stasis. D. Progressive intraaneurysmal thrombosis leads to E. aneurysm occlusion. Giordan et al. © 2013 American Academy of Neurology

Imaging Figure 2. Brain MRI shows presentation, progression and resolution of foreign body reaction. A. T1-contrast-enhanced MRI two months after treatment shows nodular enhancement in the left frontal and parietal lobes (arrowheads). B. T2-enhanced/FLAIR MRI shows marked edema/T2-changes in the region of nodular enhancement (arrow). C. Four months later MRI shows marked reduction in enhancement and D. improvement in edema/T2 changes (arrowheads). Giordan et al. © 2013 American Academy of Neurology

Intracranial foreign body reaction after endovascular procedures The clinical course and imaging findings are consistent with a foreign body reaction It can occasionally occur after endovascular treatment The phenomenon is related to a foreign body reaction to microparticles sheared from catheters/devices during endovascular procedures.1, 2 References 1. Cruz JP, Marotta T, O'Kelly C, et al. Enhancing brain lesions after endovascular treatment of aneurysms. AJNR Am J Neuroradiol 2014;35:1954-1958. 2. Lorentzen AO, Nome T, Bakke SJ, Scheie D, Stenset V, Aamodt AH. Cerebral foreign body reaction after carotid aneurysm stenting. Interv Neuroradiol 2016;22:53-57. Giordan et al. © 2013 American Academy of Neurology