Challenges in diagnosing spinal cord disease
Figure 9.1 Sagittal T2 MRI cervical spine shows a solitary area of increased T2 signal at the prior level of compression, now relieved by spinal decompressive surgery. Three-step assessment 1…
Challenges in diagnosing demyelinating brainstem disease
Figure 8.1 Axial FLAIR and T1 with gadolinium MRI brain shows abnormal signal within the left tegmentum of the pons with patchy peripheral enhancement without mass effect, with scattered T2…
Managing patients or managing the results of ancillary tests?
Figure 18.1 Case 1. Brain MRI FLAIR (a) and T2 sequences (b) showing punctate subcortical white matter lesions. None were located on the cerebellum or in the cerebellar or vestibular…
Antithrombotic management of recurrent atherothrombotic cerebrovascular disease
Figure 6.1 MRI diffusion-weighted imaging shows acute ischemia in the primary motor cortex and in neighboring white matter along the MCA–anterior cerebral artery (ACA) boundary zone (arrow). Figure 6.2 CTA…
Vascular dementia and vascular cognitive impairment
Figure 15.1 Brain CT showing two cortical strokes (left frontal lobe and right parieto-frontal lobe) and several subcortical vascular lesions. Discussion This patient had recurrent strokes and imaging evidence of…
Dilemmas in endovascular stroke therapy
Figure 8.1 MRI scans of the head. (a) Diffusion-weighted MRI scan demonstrated minimal restricted diffusion involving the left posterior limb of the internal capsule. (b) The perfusion-weighted MRI demonstrated a…
Underdiagnosis of reversible cerebral vasoconstriction syndromes
– Eclampsia-associated vasoconstriction – Drug-induced angiitis (“angiitis” is a misnomer as there is no vessel inflammation) – Migraine “angiitis” (again, a misnomer) – Thunderclap headache with reversible vasospasm – CNS…
Managing hemorrhagic stroke
Figure 17.1 CT scan of the head demonstrating an acute intracranial hemorrhage in the medulla (a, axillary image), extending into the lower pons (b, sagittal image). The remainder of the…
The diagnosis and overdiagnosis of cerebral vasculitis
Figure 11.1 Reversible cerebral vasoconstriction syndrome. (a) First brain MRI FLAIR axial section showing subcortical parieto-occipital hyperintensities. (b) Angio-MRI showing segmental narrowing of both middle, left anterior and posterior cerebral…
When the diagnostic image is not diagnostic
Figure 4.1 Non-contrast head CT axial image at the level of the basal cisterns demonstrates hyperdensity in the expected location of the basilar artery (arrow). The clinical history and abnormal…
