neuro
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Table of Contents
White Matter Dz
Multiple Sclerosis Criteria
- 1 gad enh or 9 T2 hyper lesions
- 1+ infratentorial lesions
- 1+ juxtacortical
- 3+ periventricular
Multiple Sclerosis Variants
- Devic's dz - transverse myelitis & B optic neuritis
- severe
- Balo's dz - MS lesion w/ concentric demyelination & nl brain
- Schilder's dz - acute, rapid, B symmetric demyelination
- large, well-circ involving centrum & occ lobes
- Marburg variant - repeated relapses w/ rapidly accumulating disability
Multiple Sclerosis DDx
- Lyme
- vasculidities
- HTN & ischemic wm lesions
- virchow-robin spaces
- migraine
- trauma (DAI)
- UBO's
ADEM
- Causes - measles, varicella, mumps, rubella, EBV, CMV, M. pneumoniae
- multiple, large high T2 lesions which may enhance in a nodular or ring pattern
- usually affects cerebrum but may enlarge cord
- fulminant type is acute hemorrhagic leukoencephalitis (Hurst's dz)
- diffuse multifocal perivascular demylelination & hemmorhage in cerebral WM w/ sparing of U-fibers
PML
- JC virus
- assoc w/ immunocompromise
- asymmetric parietal & frontal involvement, but can be anywhere
- low T1, high T2
- no enhancement, no mass effect
HIV
- symmetric supratentorial demyelination
- does not extend to GW junction
- no mass effect
- atrophy
SSPE
- sequela of measles infection
- patchy WM demyelination sparing U-fibers
- asymmetric gray & white matter involvement in parietooccipital region
Binswanger dz
- older men & women
- assoc w/ HTN & lacunar infarction
- broad high signal areas w/i FPO WM
- U-fibers spared
CADASIL
- inherited arterial dz
- recurrent TIA, stroke, dementia, depression, pseudobulbar palsy, hemi/quadriplegia
- F/T/insula w/ subcortical U-fiber involvement
- High T2 in WM (periventricular, deep WM, BG, brain stem)
Postanoxic Encephalopathy
- occurs after anoxic episode severe enough to produce coma
- recovery after 24-48 hrs, then precipitous decline in 2-wk period to death
- high T2 throughout WM particularly involving corpus callosum, subcortical U-fibers, int/ext capsules
- diffusion positive
PRES
- high T2 in PO cortex & SCWM
- can extend to other regions
- enhancement variable
- does not restrict
- assoc w/
- malignant HTN
- toxemia of pregnancy
- renal dz
- immunosuppressive drugs (cyclosporine, FK-501)
- antiphospholipid ab syndrome
- porphyria
Central Pontine Myelinolysis
- alcoholic, debilitated, malnourished pt's w/ rapid correction of hyponatremia
- may involve extrapontine stx (thalamus, caudate, putamen, internal external & extreme capsules, claustrum, amygdala, cerebellum, deep gray matter)
- high T2 in pons w/ peripheral sparing and sparing of CST
Trauma
Extraaxial Hemorrhage
Epidural Hematoma
- Biconvex shape (lentiform)
- Usually in the temporoparietal regions but can be in the occipital region
- Usually accompanied with a skull fracture and tear of a branch of the middle meningeal artery
- Does NOT cross suture lines, but can cross midline
- Usually has more mass effect, but not always, depending on size
Subdural Hematoma
- Subdural is crescent shaped typically along the temporoparietal regions as well, and is associated with tearing of the bridging veins
- DO cross sutures lines, but DO NOT cross midline
- Fracture less commonly associated
- Can be bilateral and also interhemispheric, and along the tentorium.
Subarachnoid Hemorrhage
- Subarachnoid you look for blood in the fissures, the basilar cisterns, interhemispheric, or in the interpeduncular fossa
- Blood in/around the circle of willis = star of texaco sign
- Blood along the posterior falx around the sinuses, you can get the delta sign
Vascular Lesions
- Approach to intraparenchymal hemorrhage
- If Ca2+ near hemorrhage think AVM
- Perform MR immediately (before blood products become bright on T1)
- If negative, f/u to resolution
- Approach to subarachnoid hemorrhage
- Obtain CTA while pt is on the table
- Non-aneurysmal SAH = Venous hemorrhage
- Perimesencephalic Cisterns
- Small amount of blood
- Asymptomatic
neuro.1555935636.txt.gz · Last modified: 2019/04/22 08:20 by nfasano