Janica walden michael solle neuroradiology
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Neuroradiology/ neuropatholgy Clinical Conference PowerPoint PPT Presentation


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Janica Walden, Michael Solle, Neuroradiology. Neuroradiology/ neuropatholgy Clinical Conference. Case 1: History. 1-2008: 26 male with ventriculomegaly & symptoms concerning for hydrocephalus with papilledema & headaches. Case 1: Head CT. Case 1: MRI (FLAIR). Case 1: MRI (CISS).

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Neuroradiology/ neuropatholgy Clinical Conference

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Janica walden michael solle neuroradiology

Janica Walden, Michael Solle, Neuroradiology

Neuroradiology/neuropatholgy Clinical Conference


Case 1 history

Case 1: History

  • 1-2008:

    • 26 male with ventriculomegaly & symptoms concerning for hydrocephalus with papilledema & headaches.


Case 1 head ct

Case 1: Head CT


Case 1 mri flair

Case 1: MRI (FLAIR)


Case 1 mri ciss

Case 1: MRI (CISS)


Case 1 surgery

Case 1: Surgery

  • Multiple cysts were visualized & removed from lateral & 3rd ventricles.


Case 1 pathology

Case 1: Pathology

  • Light Microscope:

    • Sections showed fragments of degenerating wall of a cysticercal cyst. Wall shows a small amount of calcification.

  • Diagnosis: Cysticercosis


  • Neurocystircercosis

    Neurocystircercosis

    • Cysticercosis is the most common parasitic infection in immunocompetent patients:

      • incidence is not increased in patients with AIDS,

      • Cysticercosis is generally acquired by ingesting fruits or vegetables contaminated with eggs (Taeniasolium,.

      • ingesting larvae (undercooked pork) results in intestinal teniasis.

    • Most common cause of acquired seizures.

    • Gray-white junction- hematogenous spread (?)

    • Intraventricular lesions (20-50%).

    • Subarachnoid space lesions (racemose type- cluster of grapes) (less than 10%).


    Neurocystircercosis1

    Neurocystircercosis

    • Vesicular stage:

      • cyst-like lesion w/mural nodule (larva with full bladder & scolex, generally no contrast enhancement).

    • Colloidal stage:

      • cyst dies & produces inflammatory reaction (incomplete ring-enhancing lesion w/edema).

      • Occasionally, multiple lesions are in the colloidal stage & produce an encephalitis-like picture.

    • Granular stage:

      • dead organism produces classic ring-enhancing lesion.

    • Nodular stage:

      • final stage in which lesion calcifies.


    Case 2

    Case 2:

    • History:

      • 27 male with HIV, lumbar puncture was done… & india ink stained positive for cryptococcus.


    Case 2 intial study

    Case 2: Intial study


    Case 2 1 st follow up study

    Case 2: 1st Follow up study


    Operation

    -Operation

    • A single burr hole was made. Dura was opened & underlying pia was cauterized. Following this, using stereotaxy, a biopsy needle was advanced. Once the target was achieved, mild aspiration yielded gross purulence. Multiple specimens were obtained.


    Case 2 2 nd follow up study post op

    Case 2: 2nd Follow up study, post op

    • Patient non-compliant with medications.


    Case 2 3 rd follow up study

    Case 2: 3rd Follow up study

    • Improved compliance.


    Case 2 4 th follow up study further improvement

    Case 2: 4th Follow up study, further improvement


    Iris immune reconstitution syndrome

    IRIS (immune reconstitution syndrome)

    • HIV pts initiated on retroviral therapy.

    • Restored immune system now reacting/over-reacting (?) to intact pathogens and/or residual antigens.

    • Paradoxical worsening of a known condition, or appearance of a new condition following initiation of therapy.


    Neuroradiology neuropatholgy clinical conference

    IRIS

    • Most commonly involved include CMV, mycobacterium, varicella zoster, herpes, PCP, & cryptococcus .

    • Clinical presentation involves recurrence of symptoms related to a latent TB infection, or cryptococcal meningitis.


    References

    References:

    • www.aidsrestherapy.com/content/4/1/9

    • http://en.wikipedia.org/wiki/Immune_reconstitution_inflammatory_syndrome


    Case 3

    Case 3


    Case 31

    Case 3


    Case 32

    Case 3


    Operation pathology

    Operation & pathology:

    • Right frontal sinus mass pedunculated off of the posterior table of frontal sinus, which was noted to be dehiscent. Most consistent with an encephalocele.

    • Fragments of central-nervous-system tissue, consistent with encephalocele/heterotopia.


    Case 4 history

    Case 4: History

    • 3 year old girl with presented with left leg weakness & limp x 3 weeks.

    • Fell 3 weeks prior & had been limping ever since.

    • 2 days prior to presentation she began not using her left hand.


    Neuroradiology neuropatholgy clinical conference

    Arterial spin label cerebral blood flow map.


    Case 4 pathology

    Case 4: Pathology

    • Sections show a proliferation of neoplasticastrocytes.

      • Moderate nuclear atypia & mitotic figures. No necrosis, histologic findings consistent with anaplastic astrocytoma.

    • Neoplastic cells diffusely stained for GFAP.

    • Many nuclei of neoplastic cells stained positive for p53.

    • A Ki-67 immunostain reveals a labeling index of 12% in area sampled.


    Case 5

    Case 5

    • 74 year old male with diabetes & hypertension presented with weakness/extreme fatigue, weight loss & CN V & VI palsies.


    Neuroradiology neuropatholgy clinical conference

    CT


    Findings

    Findings

    • Enhancing soft tissue mass at left petrous apex & left posterolateral wall of the left cavernous sinus.

      • Measures 1.8 cm x 1.2 cm.

      • Extends along cavernous sinus, erodes through sphenoid sinus wall.

      • Extends along cisternal portion of V & into brainstem.

    • Narrowing of adjacent left petrous internal carotid artery.


    Pathology

    Pathology

    • Acutely inflamed necrotic debris with fungal hyphae and giant cells present.


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