Review of diffuse cortical injury on diffusion-weighted imaging in acutely encephalopathic patients with an acronym: “CRUMPLED” Yasemin Koksel, John.

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Presentation transcript:

Review of diffuse cortical injury on diffusion-weighted imaging in acutely encephalopathic patients with an acronym: “CRUMPLED” Yasemin Koksel, John Benson, Haitao Huang, Mehmet Gencturk, Alexander M. McKinney European Journal of Radiology Open Volume 5, Pages 194-201 (January 2018) DOI: 10.1016/j.ejro.2018.10.004 Copyright © 2018 The Authors Terms and Conditions

Fig. 1 A 58-year-old female patient with sporadic CJD. 1A: Reduced diffusion is noted in the parasagittal cortices bilaterally as well as the basal ganglia, with additional involvement of the thalami, specifically pulvinar nuclei (arrowheads). 1B: On FLAIR, hyperintensity is noted only in the bilateral parasagittal cerebral cortices. European Journal of Radiology Open 2018 5, 194-201DOI: (10.1016/j.ejro.2018.10.004) Copyright © 2018 The Authors Terms and Conditions

Fig. 2 A 57-year-old female with RCVS presenting with “thunderclap headache”. 2A-C: several small foci of gyriform reduced diffusion were noted in the parietooccipial cortices (arrows, 2A), but less prominent than the amount of edema on FLAIR (2B), indicative of concomitant PRES, with small amounts of subarachnoid hemorrhage on T2*WI as well (arrows, 2C); MRA (not shown) suggestive mild multifocal segmental narrowing. 2D: On catheter DSA of the right ICA, multifocal areas of narrowing of ACA and MCA segments are noted (arrows), with focal narrowing of the A2 (dotted arrow) and A1 (not shown) segments as well. European Journal of Radiology Open 2018 5, 194-201DOI: (10.1016/j.ejro.2018.10.004) Copyright © 2018 The Authors Terms and Conditions

Fig. 3 A 38-year-old male patient with Ornithine transcarbamylase deficiency, has reduced diffusion in the bilateral insular and cingulate cortices on DWI (arrows, 3A) and FLAIR images (arrows, 3B). In addition, bilateral thalamic involvement seen in FLAIR images without restricted diffusion (arrowheads 3B). European Journal of Radiology Open 2018 5, 194-201DOI: (10.1016/j.ejro.2018.10.004) Copyright © 2018 The Authors Terms and Conditions

Fig. 4 A 20-year-old male with altered mental status from uremic encephalopathy, having mildly reduced diffusion in the bilateral insular and caudate nuclei on DWI (arrows, 4A-B), with subtle edema on FLAIR (arrows, 4C-D). Follow-up imaging was not obtained, as the patient’s symptoms improved with correction of the uremia and metabolic acidosis. European Journal of Radiology Open 2018 5, 194-201DOI: (10.1016/j.ejro.2018.10.004) Copyright © 2018 The Authors Terms and Conditions

Fig. 5 A 1-week-old term female with MELAS, has reduced diffusion in the bilateral perirolandic area on DWI (arrows, 5A) and delayed myelination pattern is seen on T2*WI (arrows, 5B). European Journal of Radiology Open 2018 5, 194-201DOI: (10.1016/j.ejro.2018.10.004) Copyright © 2018 The Authors Terms and Conditions

Fig. 6 A 58-years-old male with confusion from status epilepticus has reduced diffusion in the right temparoparietal and occipital cortices seen on DWI (arrows, 6A) and FLAIR image (arrows, 6B). European Journal of Radiology Open 2018 5, 194-201DOI: (10.1016/j.ejro.2018.10.004) Copyright © 2018 The Authors Terms and Conditions

Fig. 7 A 22-years-old female with seizures from PRES due to chronic renal failure and hypertension. 7A-E: Multifocal mildly reduced diffusion and edema is noted on DWI and FLAIR (arrows, 7A, 7C), not having bright vasogenic edema on ADC map (7B); there is also cytotoxic edema within the left temporal lobe on DWI (arrows, 7D), but less visible on FLAIR (7E). After therapy with subsequently resolved seizures, a follow-up FLAIR MRI 40 days later showed resolved multifocal abnormalities (7F). European Journal of Radiology Open 2018 5, 194-201DOI: (10.1016/j.ejro.2018.10.004) Copyright © 2018 The Authors Terms and Conditions

Fig. 8 A 42-years-old male with hypoxic-ischemic encephalopathy due to cardiac arrest, has reduced diffusion in perirolandic area on DWI (arrows, 8A), also bilateral basal ganglia, posterior insular and visual cortices involvement are seen (arrows, 8B), with subtle findings on FLAIR (arrows, 8C). European Journal of Radiology Open 2018 5, 194-201DOI: (10.1016/j.ejro.2018.10.004) Copyright © 2018 The Authors Terms and Conditions

Fig. 9 A 48-years-old male with end-stage liver disease, presented with myoclonic jerking, has an ammonium level of 226 μg/dl. He has restricted diffusion in frontal, parietal and occipital cortices seen on DWI and ADC (arrows, 9A-9B). European Journal of Radiology Open 2018 5, 194-201DOI: (10.1016/j.ejro.2018.10.004) Copyright © 2018 The Authors Terms and Conditions

Fig. 10 A 66-years-old male diagnosed with HSV encephalitis has reduced diffusion and edema on DWI and FLAIR image (arrows, 10A, 10B) in the parasagittal and temporal cortices bilaterally. European Journal of Radiology Open 2018 5, 194-201DOI: (10.1016/j.ejro.2018.10.004) Copyright © 2018 The Authors Terms and Conditions

Fig. 11 A 66-years-old female with loss of consciousness due to hypoglycemic coma has reduced diffusion and edema on DWI (arrows, 11A) and FLAIR images (arrows, 11B) in the bilateral parasagittal cortices. European Journal of Radiology Open 2018 5, 194-201DOI: (10.1016/j.ejro.2018.10.004) Copyright © 2018 The Authors Terms and Conditions