Author: Brent Weinberg, MD

Imaging intracranial hemorrhage – Case 4 – Arteriovenous malformation – AVM

Posted on by Brent Weinberg, MD

Imaging intracranial hemorrhage – Case 4 – Arteriovenous malformation – AVM 

This patient has a cerebellar hemorrhage. On CT angiography, there is an enhancing mass of vessels right along the tentorium which is suspicious for an underlying AVM. Conventional angiography confirms the abnormality.

AVMs are graded by their size, involvement of eloquent cortex, and venous drainage using the Spetzler-Martin grading scale. This gives a measure of operative mortality from removing the lesion and helps guide management.

The level of this lecture is appropriate for medical students, junior residents, and trainees in other specialties who have an interest in neuroradiology or may see patients with intracranial hemorrhage or stroke.

Check out the full Youtube playlist to see the entire lecture.

Imaging intracranial hemorrhage – Case 3 – PRES – posterior reversible encephalopathy syndrome

Posted on by Brent Weinberg, MD

Imaging intracranial hemorrhage – Case 3 – PRES – posterior reversible encephalopathy syndrome

Sometimes other features give you a clue as to why a patient may have hemorrhage. This patient with melanoma history was certainly concerning for metastatic disease. However, there was no underlying enhancing lesion and there were multiple other areas of white matter edema, also without enhancement.

The recent history of chemotherapy made this case suspicious for PRES, posterior reversible encephalopathy syndrome, also sometimes called acute hypertensive encephalopathy. It can be a bit confusing, because it isn’t always posterior, reversible, or encephalopathy. Hence the confusing number of names.

However, conservative management in this patient showed resolution of the majority of the findings within 4 weeks without metastatic disease.

The level of this lecture is appropriate for medical students, junior residents, and trainees in other specialties who have an interest in neuroradiology or may see patients with intracranial hemorrhage or stroke.

Check out the full Youtube playlist to see the entire lecture.

Imaging intracranial hemorrhage – Case 2 – Metastases

Posted on by Brent Weinberg, MD

Imaging intracranial hemorrhage – Case 2 – Metastases

This patient has a solitary hemorrhage in the right posterior frontal lobe. On MRI, there is a ring-enhancing lesion in this location, as well as other suspicious tiny lesions. Further systemic revealed a lung mass, and this patient has brain metastases with hemorrhage.

Metastatic disease is an important consideration in hemorrhage, especially in older patients. This makes contrast enhanced MRI a valuable tool in identifying the underlying etiology.

The level of this lecture is appropriate for medical students, junior residents, and trainees in other specialties who have an interest in neuroradiology or may see patients with intracranial hemorrhage or stroke.

Check out the full Youtube playlist to see the entire lecture.

Imaging intracranial hemorrhage – Case 1 – Hypertensive hemorrhage

Posted on by Brent Weinberg, MD

Imaging intracranial hemorrhage – Case 1 – Hypertensive hemorrhage

This is a classic case of hypertensive hemorrhage. It’s location in the basal ganglia and thalamus with intraventricular extension is typical. The patient is somewhat young, which would suggest you complete a workup with CTA and MRI to look for underlying lesions, but in this case no lesion was found.

The level of this lecture is appropriate for medical students, junior residents, and trainees in other specialties who have an interest in neuroradiology or may see patients with intracranial hemorrhage or stroke.

Check out the full Youtube playlist to see the entire lecture.

Imaging intracranial hemorrhage – systematic approach

Posted on by Brent Weinberg, MD

Imaging intracranial hemorrhage – systematic approach

This section introduces a systemic approach to imaging intracranial hemorrhage.

Specifically, what features should you be thinking about when you are imaging hemorrhage?
– How many hemorrhages there are
– Where is the hemorrhage
– What is the age of the patient
– What else is going on

Also, what should you do next when imaging a hemorrhage? Your tools include
CT angiography
MR/MR angiography
Catheter angiography

The level of this lecture is appropriate for medical students, junior residents, and trainees in other specialties who have an interest in neuroradiology or may see patients with intracranial hemorrhage or stroke.

Check out the full Youtube playlist to see the entire lecture.

Imaging intracranial hemorrhage – imaging appearance and evolution

Posted on by Brent Weinberg, MD

Imaging intracranial hemorrhage – imaging appearance and evolution

This section covers the general imaging appearance of intracranial hemorrhage.

On CT, acute hemorrhage is initially hyperdense due to high protein content within serum and red blood cells. Over time, proteinaceous contents will be cleared and the hemorrhage will become less dense.

The MRI appearance of hemorrhage is dominated by the status of hemoglobin. oxyhemoglobin is first converted to deoxyhemoglobin and then methemoglobin, all which have slightly different MR properties. It’s complex, but there are stupid mnemonic devices you can use to help.

The level of this lecture is appropriate for medical students, junior residents, and trainees in other specialties who have an interest in neuroradiology or may see patients with intracranial hemorrhage or stroke.

Check out the full Youtube playlist to see the entire lecture.

Imaging Intracranial hemorrhage – introduction

Posted on by Brent Weinberg, MD

Imaging Intracranial hemorrhage – introduction

This is the introduction chapter to a review of imaging intracranial hemorrhage. This lecture will cover general imaging appearance of intracranial hemorrhage, how it evolves over time, and a strategic approach to diagnosing causes of intracranial hemorrhage. Aneurysmal subarachnoid hemorrhage and traumatic intracranial hemorrhage are not really covered much here, with the emphasis on intraparenchymal hemorrhage.

The level of this lecture is appropriate for medical students, junior residents, and trainees in other specialties who have an interest in neuroradiology or may see patients with intracranial hemorrhage or stroke.

Check out the full Youtube playlist to see the entire lecture.

Head CT (computed tomography) radiology search pattern

Posted on by Brent Weinberg, MD

Head CT (computed tomography) radiology search pattern

For those aspiring radiologists out there, has anyone ever explained to you what you should do when you sit down at the PACS station to look at a head CT?

For those non-radiologists out there, have you ever wondered what exactly is going through a radiologists mind as they look through the images?

This video attempts to demystify a lot of that by showing exactly how you might sit down and look at a head CT on your own. It starts from the beginning and shows you what kind of images you have and where to begin as you scroll through.

The level of this video is appropriate for medical students, junior residents, and trainees in other specialties who have an interest in neuroradiology. It may also be of interest to those with an interest in radiology who are simply curious to learn more about radiology.

See this and other videos on our Youtube channel.

Basic Neuroradiology – Chapter 10 – Harm is Rare

Posted on by Brent Weinberg, MD

Basic Neuroradiology – Chapter 10 – Harm is Rare

Academic residencies have a number of safety valves that mean even when you do make mistakes, there are people there to back you up. Plus residents make mistakes about as often as faculty!

For more detailed information about resident miss rates, check out our publication reviewing a large number of independent resident studies. 

The level of this lecture is appropriate for medical students, junior residents, and trainees in other specialties who have an interest in basic concepts of neuroradiology.

Basic Neuroradiology – Chapter 9 – Don’t argue

Posted on by Brent Weinberg, MD

Basic Neuroradiology – Chapter 9 – Don’t argue

While it can seem like a good idea to argue with ordering providers, it seldom pays off in the long run. You’re essentially playing the odds that you are always right, and radiologists read A LOT of studies. Eventually you’ll be embarrassed at yourself.

Plus, much of the arguing comes from inner insecurity about having to read more studies or a complex study that you don’t understand. Be confident, advise ordering clinicians to the best of your ability, and help them.

The level of this lecture is appropriate for medical students, junior residents, and trainees in other specialties who have an interest in basic concepts of neuroradiology.