Board Review 3 – Case 16

Neuroradiology board review. This lecture is geared towards the ABR core exam for residents, but it would be useful for review for the ABR certifying exam or certificate of added qualification (CAQ) exam for neuroradiology.

More description and the answer (spoiler!) are seen below the video.

This case shows a CT of the head with scattered areas of hemorrhage centered at the gray-white matter junctions and along the corpus callosum. MRI confirms these findings, with areas of edema and susceptibility from blood products in those locations.

The diagnosis is: traumatic shear injury

In high energy traumas, areas of brain at interfaces, such as the gray-white junction, corpus callosum, and brain stem. These can be seen on CT and MRI, although MRI is more sensitive for small areas of injury. This can sometimes be referred to as diffuse axonal injury, or DAI.

Susceptibility weighted imaging (SWI) is a specialized MRI sequence tailored to detecting small areas of distortion of the magnetic field, which can be related to calcium or hemosiderin. It is a nice tool to see subtle areas of brain injury.