A 24-year-old female patient with headache. What do you see?
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Multinodular and vacuolating neuronal tumor (MVNT): Cortical ribbon-juxtacortical T2 hyperintense (a-b) round to oval nodular lesions, not suppressed on FLAIR images (c) and usually no enhancement (d) may show fair enhancement rarely, without diffusion restriction (not shown)
89-year-old female patient with aplastic anemia. Showing CT images without contrast media. What do you see?
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CT images without contrast media: Subacute isodense right subdural hematoma, revealed with narrowing of right cerebral hemispheric sulci and right lateral ventricle and minimal midline shift (red arrows), acute left subdural hematoma (blue arrow)
CT scan shows a large calcified lesion. MRI shows a large cortical-based high T2 lesion with cystic component and dark T2 foci corresponding to the calcifications. Post-contrast images show patchy enhancing areas.
DNET (usually may calcify) ganglioglioma (cystic areas, enhancing solid component, may calcify).
Bilateral asymmetrical temporal and inferomedial frontal lobes and insular cortices
What is it like?
Abnormal CT hypodensity and high FLAIR signal intensity of the affected white matter and cortex
What is the differential diagnosis?
Herpes encephalitis: affects the limbic system bilaterally, temporal lobes, insular cortices and inferolateral frontal lobes. May progress to hemorrhage. Basal ganglia is typically spared
Paraneoplastic tumor-related limbic encephalitis and autoimmune limbic encephalitis: tumour-related limbic encephalitis and autoimmune limbic encephalitis: autoimmune encephalitis. Same distribution as herpes encephalitis but the basal ganglia is frequently involved. Hemorrhage is uncommon
Metronidazole induced toxicity
Bilateral symmetric high T2 & FLAIR signal involving the dentate nuclei of the cerebellum. The appearance favors metabolic conditions particularly toxic leukoencephalopathy.
* Presenting with dizziness, vertigo and loss of coordination
What is it?
A focal expansile single lesion.
How is it like?
* With moderate perilesional edema and mass effect deforming the 4th ventricle without signs of active hydrocephalus (not shown)
* With avid enhancement
Where is it?
Left posterior fossa.
Is the lesion intraaxial (cerebral hemisphere) or extraaxial (cerebellopontine angle)?
Suggestive of extraaxial location:
1) Peripheral location and wide dural contact
2) Changes in the adjacent skull vault bone
3) Dural Tail
Definitive for extraaxial location:
1) CSF cleft.
2) Interposed vessels, cortex or dura.
The lesion is intraaxial, located in the left cerebellar hemisphere.
Which are the differentials for intra- and extraaxial posterior fossa tumours?
DIFFERENTIAL DIAGNOSTIC FOR INTRAAXIAL POSTERIOR FOSSA TUMOUR
* HEMANGIOBLASTOMA: Most frequent posterior fossa primary tumour in adults. Strong association with von Hippel Lindau disease. Cystic tumour with mural peripheral solid avidly enhancing nodule. Perilesional pathologic vessels.
* METASTASES: Most frequent posterior fossa tumour in adults. Expanisve focal lesion, single or multiple, well defined, solid-necrotic, great edema, and mass effect.
* GLIOMA: Pilocytic astrocitomas (cystic tumour with solid mural nodule) and diffuse brainstem gliomas (often low-grade, infiltrative, ill-defined lesions without enhancement) much more common in peadiatric population. High-grade gliomas (infiltrative ill-defined lesions with heterogeneous enhancement and necrosis) are uncommon in the posterior fossa.
* MEDULLOBLASTOMA: Paediatric population (more common): Intraventricular, midline; young adults; parenchymal, paramedial, focal solid enhancing lesion. Different subtypes that share hypercellularity as main feature: CT hyperdense, T2 Hypointense and difussion restriction. High propensity for CSF dissemination.
* LYMPHOMA: Focal solid enhancing single lesion or multiple cloud-like enhancing lesions. Hypercellularity as main feature: CT hyperdense, T2 hypointense and diffusion restriction.
* SUBEPENDYMOMA: Adults, intraventricular 4th ventricle. Plastic. None or little enhancement.