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Chapter 16 Neurologic Dysfunction and Kidney Disease

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1 Chapter 16 Neurologic Dysfunction and Kidney Disease
Michael J. Aminoff Copyright © 2014 Elsevier Inc. All rights reserved.

2 Copyright © 2014 Elsevier Inc. All rights reserved.
Figure 16-1 Imaging findings of a patient with seizures who was diagnosed with posterior reversible encephalopathy syndrome. A, Axial computed tomography (CT) scan demonstrates bilateral low-density involvement of the occipital lobes. B, Axial T2-weighted magnetic resonance imaging (MRI) shows high signal intensity lesions without mass effect involving white matter bilaterally in the occipital lobes. (Courtesy of William P. Dillon, MD, University of California, San Francisco.) Copyright © 2014 Elsevier Inc. All rights reserved.

3 Copyright © 2014 Elsevier Inc. All rights reserved.
Figure 16-2 Electroencephalogram (EEG) showing a diffusely slowed background with triphasic waves in a patient with uremic encephalopathy. Copyright © 2014 Elsevier Inc. All rights reserved.

4 Copyright © 2014 Elsevier Inc. All rights reserved.
Figure 16-3 Axial noncontrast CT scan shows a mixed-density left subdural hematoma producing marked mass effect on the left hemisphere and midline shift. The low density within the subdural hematoma is a feature of active hemorrhage. (Courtesy of William P. Dillon, MD, University of California, San Francisco.) Copyright © 2014 Elsevier Inc. All rights reserved.

5 Copyright © 2014 Elsevier Inc. All rights reserved.
Figure 16-4 A, Axial postcontrast T1-weighted MRI demonstrates an enhancing mass located in the right lateral recess of the fourth ventricle. B, Coronal postcontrast T1-weighted image shows an enhancing subependymal mass involving the left lateral ventricle. The findings are most consistent with CSF spread of lymphoma. (Courtesy of William P. Dillon, MD, University of California, San Francisco.) Copyright © 2014 Elsevier Inc. All rights reserved.

6 Copyright © 2014 Elsevier Inc. All rights reserved.
Figure 16-5 MRI of a patient with biopsy-proven primary lymphoma of the brain. Axial postcontrast T1-weighted MRI shows an enhancing mass involving the splenium of the corpus callosum as well as two satellite nodules within the white matter of the left posterior frontal lobe. (Courtesy of William P. Dillon, MD, University of California, San Francisco.) Copyright © 2014 Elsevier Inc. All rights reserved.

7 Copyright © 2014 Elsevier Inc. All rights reserved.
Figure 16-6 A, Axial postcontrast T1-weighted image demonstrates a ring-enhancing mass lesion in the right frontal lobe with surrounding vasogenic edema. B, Axial T2-weighted fluid-attenuated inversion recovery (FLAIR) image demonstrates a mass surrounded by a zone of increased signal intensity consistent with vasogenic edema. The mass itself consists of several layers of abnormal signal. Within the center of the mass, a zone of lower signal is seen, surrounded by alternating zones of higher and lower signal. The capsule of the mass shows low signal and is the area that enhances with contrast material (see A). C, Axial diffusion-weighted image. The central portion of the mass shows high signal, consistent with restricted diffusion. The appearance of a ring-enhancing mass containing material with restricted diffusion is most consistent with a cerebral abscess. D, Axial diffusion-weighted image at the level of the lateral ventricles shows abnormal high-signal layering within the right lateral ventricle and in the sulci of the left hemisphere, consistent with both meningeal and intraventricular extension of abscess material. (Courtesy of William P. Dillon, MD, University of California, San Francisco.) Copyright © 2014 Elsevier Inc. All rights reserved.

8 Copyright © 2014 Elsevier Inc. All rights reserved.
Figure 16-7 A, An immunosuppressed patient with alteration of mental status. Axial T2-weighted fluid-attenuated inversion recovery MRI demonstrates several discrete areas of T2 prolongation involving the right and left thalamus and the left posterior frontotemporal area. Despite the large size of the lesion, no mass effect is present. B, Axial postcontrast T1-weighted image demonstrates well-circumscribed low-intensity lesions without contrast enhancement. Subsequent brain biopsy confirmed the diagnosis of progressive multifocal leukoencephalopathy. (Courtesy of William P. Dillon, MD, University of California, San Francisco.) Copyright © 2014 Elsevier Inc. All rights reserved.

9 Copyright © 2014 Elsevier Inc. All rights reserved.
Figure 16-8 Sagittal postcontrast T1-weighted image through the cervical spinal cord and lower cerebellum demonstrating several intensely enhancing pial-based hemangioblastomas (arrows) associated with nonenhancing cysts. (Courtesy of William P. Dillon, MD, University of California, San Francisco.) Copyright © 2014 Elsevier Inc. All rights reserved.

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