case presentation n.
Download
Skip this Video
Loading SlideShow in 5 Seconds..
Case presentation PowerPoint Presentation
Download Presentation
Case presentation

Loading in 2 Seconds...

play fullscreen
1 / 39

Case presentation - PowerPoint PPT Presentation


  • 79 Views
  • Uploaded on

Case presentation. Sharon H. de Kock August 2012. 33yr female Referred with hx of numbness of 1 st 2 digits of Rt hand, also focal convulsions affecting the Rt corner of her mouth. According to pt she was healthy before Feb ‘12. No other relevant hx / illnesses. CLINICAL HISTORY.

loader
I am the owner, or an agent authorized to act on behalf of the owner, of the copyrighted work described.
capcha
Download Presentation

PowerPoint Slideshow about 'Case presentation' - gayora


An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -
Presentation Transcript
case presentation

Case presentation

Sharon H. de Kock

August 2012

clinical history

33yr female

  • Referred with hx of numbness of 1st 2 digits of Rt hand, also focal convulsions affecting the Rt corner of her mouth.
  • According to pt she was healthy before Feb ‘12.
  • No other relevant hx/ illnesses.
CLINICAL HISTORY
clinical examination

GCS 15/15

  • Orientated to place, person, time.
  • Higher functions in tact.
CLINICAL EXAMINATION
special investigations

CXR

  • MRI of Brain & Spine
  • Scintigram
SPECIAL INVESTIGATIONS
mri findings

Multiple high signal nodules and mass on T1.

  • Involving the cerebrum and cerebellum.
  • Intra-axial.
  • Largest in Lt parietal region approx 3.5 x 4 cm axially & 4.5 cm cranio-caudally.
  • Largest in post fossa on Lt approx 1.3 cm CC & 2 x 2.2 cm axially.
  • Spectroscopy of Lt large parietal mass: lactate peak suggestive of necrosis/ infection, no increased Ch/NAA ratios.
MRI FINDINGS
mri findings cont

Vasogenic oedema surrounding mass cause mass effect on lat ventricle and midline.

  • Basal cisterns patent.
  • Prominent post C enhancement.
  • Central necrosis.
  • GE: blooming artefact suggestive of hemosiderin & chronic blood.
MRI FINDINGS cont.
mri findings cont spine

No abnormal signal changes in the spinal cord.

  • Few high signal intensity lesions in the vertebral bodies- T4, T11 & L4- ?fat.
MRI FINDINGS cont. (spine)
diff dx

Haemorrhagic mets.

  • Meningealmelanotosis
  • Neuro-cutaneousmelanosis.
DIFF DX
t1 physics

T1 relaxation is the process of longitudinal magnetization recovery after applying a RFP/ excitation to invert the vector.

  • Occurs as energy from the spinning nuclei is dissipated into surrounding areas.
  • Substances with intrinsic shorter T1 relaxation times demonstrate higher signal intensity on T1WI.
T1 PHYSICS
high signal intensity on t1wi

Various natural occurring substances are responsible- (reduce T1 relaxation time)

*methemoglobin, *melanin, * lipid, *protein, *calcium, *iron, *copper and *manganese.

HIGH SIGNAL INTENSITY ON T1WI
methemoglobin containing lesions

Physical Properties:

- MRI appearance of haemorrhages &

lesions containing blood depends on the

age of the blood.

- intracellular methemoglobin= early sub-

acute phase haemorrhage, 3-7d after

onset.

- extracellular methemoglobin= late sub-

acute phase, 8d-1mnth after onset.

METHEMOGLOBIN-CONTAINING LESIONS
methemoglobin containing lesions physical properties cont

- produce T1 shortening effects.

- therefore have intrinsically high signal

intensity on T1WI.

- attributed to paramagnetic interactions.

METHEMOGLOBIN-CONTAINING LESIONS, Physical Properties cont.
methemoglobin containing lesions1

Cavernous Malformations:

- congenital/ acquired vascular anomalies.

- occur in approx. 0.5% of general

population.

  • Cerebral Venous Thrombosis:

- unusual condition.

METHEMOGLOBIN-CONTAINING LESIONS
melanin containing lesions

Physical Properties:

- demonstrate high signal intensity on

T1WI because of the paramagnetic

effects of stable free radicals and metal

scavenging effects.

MELANIN-CONTAINING LESIONS
melanin containing lesions1

Metastatic Melanoma:

- intracranial mets occur in nearly 40% of

pts with malignant melanoma.

- high signal intensity also can result from

haemorrhage within these lesions.

  • Prim Diffuse MeningealMelanomatosis:

- aggressive form of prim intracranial

melanoma, extremely rare.

MELANIN-CONTAINING LESIONS
melanin containing lesions cont

NeurocutaneousMelanosis:

- uncommon congenital condition

characterized by multiple giant or hairy

nevi and melanin containing lepto-

meningeal lesions without evidence of

extracranial melanoma.

MELANIN-CONTAINING LESIONS, cont.
lipid containing lesions

Physical Properties:

- short T1 relaxation time of hydrogen

nuclei within lipid molecules.

- produces high signal intensity on T1WI.

LIPID-CONTAINING LESIONS
lipid containing lesions1

Intracranial Lipomas:

- rare congenital malformation.

- arise from abnormal differentiation of

the persistent primitive meninx.

- commonly occur in pericallosal region,

often associated with disgenesis or

agenesis of the corpus callosum.

LIPID-CONTAINING LESIONS
lipid containing lesions cont

Teratomas:

- true neoplasms, usually contain tissue

derived from all three germ cell layers.

- mostly benign, malignant variants exist.

- most frequently found in the cerebral

hemispheres and pineal gland.

  • Dermoid Cysts:

- rare, benign, congenital ectodermal

inclusion cysts, commonly in midline.

LIPID-CONTAINING LESIONS, cont.
protein containing lesions

Physical Properties:

- high signal intensity of certain lesions on

T1WI can be attributed to their protein

content and the hydration layer effect.

PROTEIN-CONTAINING LESIONS
protein containing lesions1

Colloid Cyst:

- uncommon benign intracranial lesions.

- contain gelatinous material.

- occur characteristically at the antero-

superior aspect of the 3rd ventricle.

  • Rathke Cleft Cyst:

- common benign remnants of the Rathke

cleft, may be located in sellar-/ supra-

sellar compartment.

PROTEIN-CONTAINING LESIONS
mineral containing lesions

Physical Properties:

- Calcium is a diamagnatic substance that

may appear bright on T1WI.

- Other minerals that have T1 shortening

effects include manganese, copper and

iron.

MINERAL-CONTAINING LESIONS
mineral containing lesions1

Hepatic Encephalopathy:

- characteristically manifests as bilateral

regions of high signal in the lentiform

nucleus and substantianigra on T1WI.

- related to the accumulation of

manganese.

  • Wilson Disease:

- rare autosomal recessive condition.

- resultant abn copper metabolism & acc.

- basal ganglia & thalami commonly affected.

MINERAL-CONTAINING LESIONS
take home point

Familiarity with substances and physical properties that contribute to T1 shortening is helpfull to formulate an appropriate Diff Dx.

TAKE HOME POINT
references

Intracranial Lesions with High Signal Intensity on T1-weighted MR Images: Differential Diagnosis, RadioGraphics 2012; 32:499-516.

  • Grainger & Allison’s Diagnostic Radiology, 5th Edition, Volume 2.
REFERENCES