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Cerebral Vasculitis Occurring With A Corpus Callosum Infarction

Cerebral vasculitis is a known cause of ischemic and hemorrhagic strokes and has been described as one of the rare but important causes of corpus callosum infarction. Biopsy-proved giant cell arteritis causing callosal infarction is an exceedingly rare finding because a tissue specimen is usually not obtained and conclusions are drawn on the basis of clinical and radiologic findings alone. We present a case of callosal infarction, which evolved and eventually affected large portions of both cerebral hemispheres.

A 63-year-old woman presented to our hospital with left-sided numbness and neglect, cognitive changes, and apraxia. One month earlier, she was found to have a C-reactive protein level of 8.0 mg/dL (normal <0.5 mg/dL) and 75% stenosis in both femoral arteries. These results prompted Read more »

*This blog post was originally published at AJNR Blog*

Case Report: 21-Year-Old Male Experiencing Auditory And Visual Hallucinations

Bilateral symmetric claustrum lesions shown on MR imaging are rarely reported, especially transient and reversible lesions associated with seizures, such as herpes simplex encephalitis,1 unidentified encephalopathy,2 and acute encephalitis with refractory repetitive partial seizures.3 To our knowledge, there are no reports of symmetric bilateral claustrum lesions with mumps encephalitis.

A 21-year-old man had been experiencing cold like symptoms with headache and fever for a week when he vomited and had a tonic-clonic seizure and was subsequently taken to a nearby emergency hospital (day 1). He had been noticing spasms on the left side of his face for 2 days.  On his last visit to the hospital, he reported disorientation accompanied by fever; however, a brain MR imaging and CSF analysis showed no abnormalities. Because he was instatus epilepticus on hospitalization, midazolam was administered by intravenous infusion at 3.0 mg/h. Around this time, the patient started to experience visual hallucinations and reported seeing Read more »

*This blog post was originally published at AJNR Blog*

A Rare MRI Finding In Multiple Sclerosis

Gray matter (GM) damage, in terms of focal lesions,1 “diffuse” tissue injury, and atrophy is a well-known feature of multiple sclerosis (MS). Recently, T1-hyperintensity on unenhanced T1-weighted sequences has been found in the dentate nuclei of patients with MS with severe disability and high T2 lesion load.2 Such an abnormality has been interpreted as an additional sign of the neurodegenerative processes known to occur in the course of MS. This report describes a patient who, despite being mildly disabled and having a low T2 lesion load and no evident brain atrophy, showed a bilateral dentate nucleus T1 hyperintensity.

The patient was a 44-year-old man who had a diagnosis of relapsing-remitting MS (RRMS) in September 1997, after 3 relapses that occurred in June 1995, March 1997, and September 1997. Brain and cord MR imaging and CSF examination were suggestive of MS. After the diagnosis, he started treatment with interferonβ-1α, with clinical stability until January 2009, when he complained of vertigo, which gradually resolved after 5 days of steroidtreatment (methylprednisolone, 1 g daily intravenously). In September 2010, he entered a research protocol and underwent neurologic and neuropsychologic (Rao Brief Repeatable Neuropsychological Battery) evaluations and brain MR imaging on a 3T scanner. The neurologic examination showed Read more »

*This blog post was originally published at AJNR Blog*

Case Report: A Third Cerebellar Hemisphere?!

Improved visualization of the posterior fossa structures has led to an increased recognition of cerebellar malformations, including the Dandy-Walker malformation, Joubert syndrome, rhombencephalosynapsis, tectocerebellar dysrhaphia, and so forth. New anomalies continue to be discovered, highlighting the fact that cerebellar anomalies are poorly understood and have largely been ignored in the literature. We present a structural anomaly of the cerebellum, which we believe has not been previously reported.

A 16-month-old girl presented to the pediatric outpatient department with some delayed developmental milestones. She was full-term with a normal vaginal delivery and no history suggestive of perinatal asphyxia. The motor milestones were delayed, and the child could not stand. The other milestones, including language and socialization, were normal. Examination revealed a bony hard swelling in the occipital region, which, according to the mother, was noticed soon after birth. The occipitofrontal circumference was 52 cm, and the anterior fontanelle was open. There was generalized hypotonia, and the deep tendon reflexes were depressed. Mild truncal ataxia was observed, but there was no nystagmus. Read more »

*This blog post was originally published at AJNR Blog*

Case Report: A Craniopharyngioma In The Prepontine Cistern

We report a pathologically proved craniopharyngioma in the prepontine cistern. A 50-year-old woman presented with swallowing difficulty for 1 month. She underwent brain MR and CT imaging.

T1-weighted, T2-weighted, and contrast-enhanced T1-weighted images showed a large peripheral enhancing cystic mass in the prepontine cistern. Inside the lesion, high signal intensity (SI) on T1 and low SI on T2-weighted imaging were noted (Fig 1). The CT scan showed features similar to those on the MR images, except for the addition of a peripheral small calcification in the cystic lesion. We could not find any connection between the mass in the prepontine cistern and the sellar or parasellar area. The mass was partially surgically removed, and histopathologic examination revealed craniopharyngioma in the prepontine cistern.

  • Figure 1
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  • Fig 1. A 50-year-old woman with a craniopharyngioma in the prepontine cistern. A, Sagittal T1-weighted image shows a cystic mass in the prepontine cistern. B, Contrast-enhanced T1-weighted sagittal image shows a peripheral enhancing cystic mass in the prepontine cistern. Read more »

*This blog post was originally published at AJNR Blog*

Latest Interviews

IDEA Labs: Medical Students Take The Lead In Healthcare Innovation

It’s no secret that doctors are disappointed with the way that the U.S. healthcare system is evolving. Most feel helpless about improving their work conditions or solving technical problems in patient care. Fortunately one young medical student was undeterred by the mountain of disappointment carried by his senior clinician mentors…

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How To Be A Successful Patient: Young Doctors Offer Some Advice

I am proud to be a part of the American Resident Project an initiative that promotes the writing of medical students residents and new physicians as they explore ideas for transforming American health care delivery. I recently had the opportunity to interview three of the writing fellows about how to…

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Latest Book Reviews

Book Review: Is Empathy Learned By Faking It Till It’s Real?

I m often asked to do book reviews on my blog and I rarely agree to them. This is because it takes me a long time to read a book and then if I don t enjoy it I figure the author would rather me remain silent than publish my…

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The Spirit Of The Place: Samuel Shem’s New Book May Depress You

When I was in medical school I read Samuel Shem s House Of God as a right of passage. At the time I found it to be a cynical yet eerily accurate portrayal of the underbelly of academic medicine. I gained comfort from its gallows humor and it made me…

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Eat To Save Your Life: Another Half-True Diet Book

I am hesitant to review diet books because they are so often a tangled mess of fact and fiction. Teasing out their truth from falsehood is about as exhausting as delousing a long-haired elementary school student. However after being approached by the authors’ PR agency with the promise of a…

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