Neuroradiology Unknowns

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Presentation transcript:

Neuroradiology Unknowns Wei Xiong, M.D. Neurology Clerkship Director Case Western Reserve University School of Medicine

MCA Superior Division Infarction (CT w/o contrast) An 87 year-old man with atrial fibrillation was found with a right gaze preference and a left hemiparesis affecting the arm and lower face more than the leg.

Basal Ganglia (Putamen) Intracerebral Hemorrhage (CT w/o contrast) A 52 year-old man with a history of hypertension developed a headache, aphasia and right sided weakness over thirty minutes.

Subarachnoid Hemorrhage (CT w/o contrast) A 35 year-old woman developed an explosive headache followed by nausea and vomiting.

Large MCA Infarction (MRI – FLAIR) An 84 year old woman was found with a dense right hemiparesis and global aphasia.

Glioblastoma - Frontal Lobe (MRI – T2, T1 w/ gad) A 33 year-old woman presented with a blunted affect and depression.

Acute Subdural Hematoma (CT w/o contrast) A 72 year-old man developed a change in personality and mild weakness of the left arm and leg, which he denied.

Herpes Simplex Encephalitis (MRI – FLAIR) A 28 year-old man presented with headache, fever and a change in personality.

Brain Abscess (MRI – T1 w/o and w/ gad) A 37 year-old man presented with a week of progressive fever, headache, confusion and left sided weakness.

Herniated C5-6 Disk (MRI – T2 sagittal and axial) A 58 year-old woman developed right neck and shoulder pain followed by paresthesias down the right arm. On examination, her right biceps reflex was depressed. The right knee and ankle reflexes were pathologically brisk.

Right MCA occlusion (MRA) A 67 year-old woman developed the abrupt onset of a left hemiplegia. The initial clinical diagnosis was a pure motor hemiparesis (lacunar stroke). However, in the ER, she was found to be in new onset atrial fibrillation.

Multiple Sclerosis (MRI – FLAIR) A 34 year-old woman presented with right facial numbness. She had left optic neuritis two years ago.