Diagrammatic representation of syringomyelia and the “presyrinx” hypothesis in the setting of obstruction to CSF flow. Diagrammatic representation of syringomyelia.

Slides:

Advertisements

Similar presentations

Barak Bar M.D. UCSF Department of Neurology

Advertisements

Discovering the Origin of Syrinx Fluid. Syringomyelia Fluid collection within the center of the spinal cord that expands the diameter of the spinal cord.

IN THE NAME OF GOD

Spinal Cord and Root Compression

The ROC curve in each parameter.

A 28-year-old woman with spinal CSF leak syndrome.

Corresponding midsagittal CT (left), MR (middle), and registered (right) images of the cervical spine show proper alignment and the relationship between.

A 24-year-old patient after a motor vehicle crash with closed head injury; no fracture was identified in the cervical spine or craniocervical junction.

Patient 2. Patient 2. A, An axial T1-weighted postcontrast image with fat saturation (600/13/2) demonstrates an irregular mass centered at the right cerebellopontine.

Two axial images from the same case of a facial nerve schwannoma involving the right mastoid segment of the facial nerve canal. Two axial images from the.

A 30-year-old man with PSA

A, Brachial neuritis with long thoracic nerve neuritis.

Case 1: spontaneous spinal cord herniation.

A and B, Sagittal (A) and axial (B) fast spin-echo images of the cervical spine before treatment demonstrate diffuse increase in signal intensity (arrows)

A and B, The superior sagittal sinus (straight arrow), straight sinus (arrowhead), and vein of Galen (curved arrow) are clearly depicted, and were seen.

A, Sagittal T2WI MR image demonstrates a focal dorsal indentation (arrow) in the thoracic spinal cord. A, Sagittal T2WI MR image demonstrates a focal dorsal.

A, T2WI MR image demonstrates a focal dorsal indentation in the upper thoracic spinal cord (arrow). A, T2WI MR image demonstrates a focal dorsal indentation.

Demonstration of a bilaterally duplicated hypoglossal canal.

Normal kinetics of CSF at C2 and C6 levels (volunteer 15).

9-year-old girl with hydrocephalus and hydromyelia

Differences in the tonsillar and obex positions between patients with IIH and healthy controls. Differences in the tonsillar and obex positions between.

Multiple acute nerve root avulsions.

MRN technique. 3T MR neurography imaging sequences with isotropic multiplanar reconstruction. 3D T2 SPACE with multiplanar reconstruction of the cervical.

Patient 3. Patient 3. A, Sagittal T2-weighted image (4000/108eff /4) obtained when the patient had no symptoms referable to the spinal cord shows a mild.

Diagrammatic representation of CSF flow under normal circumstances.

Stretch injury with suprascapular neuropathy.

Longitudinal sonogram of a predominantly anechoic TDC with internal debris and thick walls (solid white arrows) below the level of the hyoid bone (black.

Patient 1. Patient 1. A, Sagittal T1-weighted image (600/8/2) shows a Chiari I malformation, with tonsillar herniation to the mid-C2 level and a pointed.

A, Sagittal T2WI MR image demonstrates a typical intraspinal extramedullary arachnoid cyst. A, Sagittal T2WI MR image demonstrates a typical intraspinal.

Spinal cord AVM diagnosed with myelography and angiography.

A 33-year-old woman with spinal CSF leak syndrome and multiple CSF leaks in the bilateral thoracic and lumbar spine. A 33-year-old woman with spinal CSF.

A, The pathophysiology of atrophy.

Coronal gadolinium-enhanced T1-weighted image (TR/TE/NEX, 500/15/2) at the level of the foramen ovale shows a significantly enhancing V3 branch (arrow)

AP (A) and lateral (B) radiographs demonstrating a discontinuous segment of the catheter, with broken catheter ends in the subcutaneous tissue of the lower.

Sagittal T2 conventional MR image in a 50-year-old patient admitted for recent gait and urinary dysfunction, with a medical history of chronic headaches.

Comparison of MR angiography with catheter angiography in a patient with a SDAVF. A, Sagittally oriented T2-weighted image displaying the signal intensity.

A, Sagittal view through the brain stem and cervical spinal cord shows the extent of T2 hyperintensities involving the pyramidal tract and posterior columns.

A 43-year-old woman initially diagnosed with Chiari I and treated with surgical decompression. A 43-year-old woman initially diagnosed with Chiari I and.

A, Sagittal SS-FSE T2-weighted image demonstrates a small posterior fossa with displacement of the cerebellar vermis inferiorly, consistent with a Chiari.

Images reveal arachnoid granulations in a 54-year-old man with headaches who had normal results of an MR imaging study.A, Sagittal reconstruction image.

Greitz and Greitz's theory on the pathogenesis of hydrocephalus.

A–C, Sagittal T1-weighted (A), sagittal T2-weighted (B), and axial T2-weighted (C) MR images of the cervical spine in a patient with severe myelopathy.

A, Sagittal fast spin-echo (FSE) T2-weighted image of the cervical and upper thoracic spine shows a mass of very low signal intensity (arrows) within the.

Case 2: Agenesis of the left ICA

Patient with 9/10 concordant unilateral mastoid and occipital head pain associated with uncovertebral tear. Patient with 9/10 concordant unilateral mastoid.

Coronal anatomic diagram depicts multiple bilateral giant perivascular spaces (PVSs) in the mesencephalothalamic region. Coronal anatomic diagram depicts.

Cervical syrinx cavity demonstrated by myelography and myelocystography. Cervical syrinx cavity demonstrated by myelography and myelocystography. A, Frontal.

Bone algorithm CT images from the same case, demonstrating focal enlargement of the right tympanic segment, in the axial (left) and coronal (right) planes.

A–C, Midsagittal cervical lateral T2-weighted image (2200/80/1) (A) and axial T2-weighted image (4000/90/2) through the cervical medullary junction (B)

Sagittal reconstruction of a CT scan of a 6-year-old boy (patient 3) after a fall (GCS = 15) demonstrates an REH (thick white arrow), which causes mild.

Type 2. Type 2. White matter abnormalities, especially around the trigones. FLAIR image of a 4-year-old patient (case 22) (A) with an ATRX mutation of.

A–C, FLAIR (TR/TE, 9002/149. 5), DWI (10000/105

Fourth ventricular CSF pulsation artifact in four subjects.

Magnified view of the axial images of the cervical spine at a comparable level (CT scan, left; MR image, center; registered image, right). Magnified view.

Sagittal MPRAGE (A) and axial T2-weighted (B) images demonstrate extensive focal cortical dysplasia (arrow) involving most of the visualized left frontal.

Sagittal MDCT image of the craniocervical junction demonstrates the AOI, which is calculated by drawing a line perpendicular to the articular surfaces.

Patient with “classic” MR imaging findings of SIH on brain MR imaging.

Axial T2-weighted MR image shows normal flow void in the right internal jugular vein (arrows), whereas flow-related enhancement can be seen in the left.

A 59-year-old woman with bilateral descending thoracic vertebral arteries. A 59-year-old woman with bilateral descending thoracic vertebral arteries. A,

MR images in a 69-year-old woman with cervical and thoracic back pain.

Short-interval follow-up cervical MR imaging of a 67-year-old male ASIA A patient with SCI. T2-weighted FSE images were obtained from an initial MR imaging.

Macroscopic study in an adult spine.

Magnified lateral projections of bilateral ICA angiography (A, right; -B, left) show only minimal collateral flows (arrows) from lenticulostriates over.

T2 weighted sagittal MR shows a Chiari I malformation with tonsillar ectopia (9 mm) at the cranio–cervical junction, resulting in disruption of normal.

Abnormal pedicle marrow signal in a malignant VCF

Patient sample 2. Patient sample 2. MR imaging of a 33-year-old woman (patient 9) with post-LP syndrome before (A and C) and on follow-up after successful.

Adult patient, BMI 49, with bowel incarceration requiring an operation, now with altered mental status. Adult patient, BMI 49, with bowel incarceration.

Patient 3. Patient 3. A, Initial sagittal T1-weighted image (600/8/2 [TR/TE/excitations]), obtained 120 hours after symptom onset, reveals a long-segment.

Axial fluid-attenuated inversion recovery MR of same patient as in Fig 1 done 19 days later (patient remained hospitalized) now showing an isointense area.

Sagittal scout view sequences are used as localizers to select the anatomic levels for flow quantification. Sagittal scout view sequences are used as localizers.

Presentation transcript:

Diagrammatic representation of syringomyelia and the “presyrinx” hypothesis in the setting of obstruction to CSF flow. Diagrammatic representation of syringomyelia and the “presyrinx” hypothesis in the setting of obstruction to CSF flow. A, Sagittal view of the craniocervical junction in a patient with a Chiari I malformation shows abnormal descent of the cerebellar tonsil below the level of the foramen magnum (arrow). A segment of spinal cord parenchyma (box) is magnified in B to D, which represent views of CSF dynamics at the level of the spinal cord parenchyma in the presence of alterations in normal CSF flow and variable patency of the central canal. B, Focal noncommunicating syrinx. In the setting of a Chiari I malformation and a variably stenotic central canal (which is a normal variant in many adults), as the tonsils descend rapidly during systole, CSF is driven into the spinal cord parenchyma by increased CSF pressure (thick vertical arrow). Net CSF flow occurs toward the central canal, resulting in focal syringomyelia, which is limited in its craniocaudal extent by intervening stenosis of the central canal. CC = central canal, A = arachnoid, P = pia, SAS = subarachnoid space, PVS = perivascular space. C, Extensive noncommunicating syrinx. This situation is similar to B, but the central canal is more extensively patent. In this situation, a long-segment dilatation of the central canal occurs as CSF is driven into the central canal (curved arrows) via the perivascular spaces by the accentuated CSF pulse pressure (thick vertical arrow) that results from the downward motion of the low-lying cerebellar tonsils in systole. D, “Presyrinx.” In the setting of altered CSF flow, as with a Chiari I malformation, fluid in the subarachnoid space is subjected to increased pressure (thick vertical arrow). Net CSF flow is into the spinal cord parenchyma; however, because the central canal is not patent (as indicated by the horizontal lines), fluid cannot accumulate within the central canal (curved arrows) and, therefore, diffuses through the cord parenchyma (stippled area), resulting in cord enlargement and edema. Nancy J. Fischbein et al. AJNR Am J Neuroradiol 1999;20:7-20 ©1999 by American Society of Neuroradiology