Board Review 2 – Case 8

Posted on December 2, 2018 by Brent Weinberg, MD

Board Review 2 – Case 8

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 patient is a young patient with seizures. Imaging shows a small and somewhat cystic mass in the right temporal lobe. There is minimal surrounding FLAIR abnormality, with minimal enhancement on post-contrast imaging.

There is a differential for low grade appearing masses in the temporal lobe which includes ganglioglioma, dysembryoplastic neuroepithelial tumor (DNET), and pleomorphic xanthoastrocytoma (PXA). You will not always be able to tell the difference. Gangliogliomas are said to be more likely to enhance than DNET, but this is frequently not the case (as in this case).

The diagnosis is: ganglioglioma.

Ganglioglioma is the most common neoplastic cause of seizures, and are commonly found in younger patients and in the temporal lobes.

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Board Review 2 – Case 7

Posted on December 2, 2018December 2, 2018 by Brent Weinberg, MD

Board Review 2 – Case 7

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

This case shows a suprasellar mixed solid and cystic mass. There is relative preservation of the normal pituitary, which makes adenoma less likely. There is mass effect on the optic chiasm, which probably accounts for the patients visual symptoms.

The diagnosis is: craniopharyngioma. There are two major types of craniopharygioma, adamantinous and papillary. Adamantinous are more common in younger patients and more likely to have calcification.

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Board Review 2 – Case 6

Posted on December 2, 2018December 2, 2018 by Brent Weinberg, MD

Board Review 2 – Case 6

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

This case shows a CT with hyperdense blood tracking in the left basal ganglia and thalamus. Although the patient is relatively young, the location is strongly suspicious for hypertensive hemorrhage. Further evaluation for underlying causes, such as a vascular malformation or tumor, is warranted with vascular imaging (such as CTA) and MRI.

The diagnosis is: hypertensive hemorrhage

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Board Review 2 – Case 5

Posted on November 17, 2018December 2, 2018 by Brent Weinberg, MD

Board Review 2 – Case 5

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

This case shows a patient with headache. Images are from an MR angiogram of the neck. The first few images show absence of filling of the left vertebral artery. This could theoretically be from atherosclerotic disease or thrombosis, but there is filling on a contrast enhanced MRA of the neck. This is because the flow in the vertebral artery is reversed in the setting of occlusion of the proximal subclavian artery.

The diagnosis is: subclavian steal

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Board Review 2 – Case 4

Posted on November 17, 2018 by Brent Weinberg, MD

Board Review 2 – Case 4

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

This case shows an older woman with hyperdensity in the basal ganglia and cerebellar hemispheres on CT. The abnormality on MRI is T1 hypointense and has susceptibility artifact. The findings are most consistent with abnormal calcium deposition.

The diagnosis is: idiopathic basal ganglia calcification (Fahr disease)

There are a number of causes of calcification in the brain, some secondary (hyperparathyroidism) and this disease, which is a familial condition.

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Board Review 2 – Case 3

Posted on November 17, 2018January 15, 2019 by Brent Weinberg, MD

Board Review 2 – Case 3

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

This case shows a patient with a coagulation disorder and new neurologic symptoms. FLAIR images show hyperintensity in the right transverse and sigmoid sinus. The abnormality is confirmed on magnetic resonance venogram, which shows absence of flow in that region. There is a filling defect on postcontrast imaging.

The diagnosis is: dural sinus thrombosis

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Board Review 2 – Case 2

Posted on November 17, 2018November 17, 2018 by Brent Weinberg, MD

Board Review 2 – Case 2

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

This case shows a patient with hearing loss some thickening of the bone in the external auditory canals. It is bilaterally symmetric and causes severe EAC narrowing.

The diagnosis is: surfer’s ear, or exostosis of the external auditory canal.

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Board Review 2 – Case 1

Posted on November 17, 2018November 17, 2018 by Brent Weinberg, MD

Board Review 2 – Case 1

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

This case is a mass in the right cerebellopontine angle and internal auditory canal. The differential for these masses includes schwannoma, meningioma, arachnoid cyst, and epidermoid. The key to differentiating this mass from others are that it is solid, centered in the internal auditory canal, and has a few areas of cystic degeneration or necrosis.

The diagnosis is: vestibular schwannoma

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Board Review 2 – Introduction

Posted on November 17, 2018 by Brent Weinberg, MD

Board Review 2 – Introduction

This video is a brief introduction before beginning the case style review.

Introduction to Neuroradiology Board Review: Part 2

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Neuroradiology Unknown Videos – Case 1

Posted on September 8, 2018 by Brent Weinberg, MD

Neuroradiology Unknown Videos – Case 1

This unknown case is a 58 year-old presenting with confusion and transient weakness. The CT and MR show a large mass in the left frontal lobe as well as an additional mass in the posterior right frontal lobe.

The key points of this video are how to deal with creating a differential diagnosis in a patient with multiple enhancing masses. Generally speaking, the differential will include metastasis, lymphoma, glioblastoma, and infection. However, by using some more subtle clues you can often make a pretty good guess about which one it will be, which may help your surgeons as they go in for biopsy.

This will be part of an unknown case series that will be continuously updated. See the full playlist below:

Youtube Playlist