ASPNR INTERESTING CASE SESSION...ASPNR INTERESTING CASE SESSION ASNR 54 th Annual Meeting May 23, 2016 Erin Simon Schwartz, MD, President Susan Palasis, MD, Vice-President Ashok Panigrahy,

ASPNR INTERESTING CASE SESSION ASNR 54th Annual Meeting

May 23, 2016

Erin Simon Schwartz, MD, President

Susan Palasis, MD, Vice-President

Ashok Panigrahy, MD, Secretary

Arastoo Vossough, MD, PhD, Treasurer

and

Laurence Eckel, MD, Treasurer

May 24, 2016

IN WHAT YEAR WAS THE ASPNR FOUNDED?

A.1992

B. 1993

C.1994

D.1995

E. 1996

IN WHAT YEAR WAS THE ASPNR FOUNDED?

A.1992

B. 1993

C.1994

D.1995

E. 1996

ESS CASE 1

11 year old girl “progressively obtunded and vomiting”

A. Subdural hygromas

B. Subarachnoid hemorrhage

C. Anemia

D. Iatrogenic effect

WHAT IS THE DIAGNOSIS?

A. Subdural hygromas

B. Subarachnoid hemorrhage

C. Anemia

D. Iatrogenic effect


Additional history we found in the medical record:

Patient with seizures and rapidly declining mental status after local anesthetic (mepivicaine) injected for dental procedure

INTRAVASCULAR LIPID ADMINISTRATION

• Lipid infusions increasingly being used to treat local

anesthetic systemic toxicity (LAST)

• Possible antidotal effect of intravenous lipid emulsion

on action of lipophilic drugs, including local

anesthetics, first discovered in 1962

• First case reports of success in human in 2006 • Controversial, however, as efficacy and safety not clearly proven

Lipid Rescue - Efficacy and Safety Still Unproven. Höjer J, Jacobsen D, Neuvonen PJ, Rosenberg PH. Basic Clin Pharmacol Toxicol. 2016 May 2. doi: 10.1111/bcpt.12607. [Epub] PMID: 27136445

SP CASE 1

• 7 month old previously healthy full term male

• Found unresponsive in daycare

• Caregiver stated that the baby choked while taking the bottle

Non C+ CT

3D Volume rendering

+ Retinal hemorrhages

Negative skeletal survey

T2 FSE T2 FSE FS

TOF MRA TOF MRV

A. Abusive head trauma

B. Vitamin K deficiency

C. Osler-Weber-Rendu syndrome

D. Menkes disease


A. Abusive head trauma

B. Vitamin K deficiency

C. Osler-Weber-Rendu syndrome

D. Menkes disease


OSLER-WEBER-RENDU SYNDROME

• Osler–Weber–Rendu syndrome (Hereditary hemorrhagic telangiectasia (HHT))

• Autosomal dominant genetic disorder that leads to abnormal blood vessel formation in the skin, mucous membranes, and organs

OSLER-WEBER-RENDU SYNDROME

Digital Subtraction Angiography

ABUSIVE HEAD TRAUMA SUBDURALS

T2 FSE

• Mixed intensity SDH

• Hematohygromas

VITAMIN K DEFICIENCY

• Early (within 24 hrs), Classic (1-7 days of life), and Late (2-24 weeks)

• Neonates and infants at risk because Vit K transfer through the placenta is limited

T2 T1

MENKES DISEASE

• X-linked recessive disorder of transmembrane copper (Cu) transport

• Rapid CNS degeneration

• Elastin collagen formation • Fragile, tortuous vessels

• Predisposition to ischemia

• Rapid brain atrophy leads to SDH

WHO WAS THE FIRST ASPNR PRESIDENT?

A.Thomas P Naidich

B. Robert A Zimmerman

C.James A Brunberg

D.A James Barkovich

E. Patrick D Barnes

WHO WAS THE FIRST ASPNR PRESIDENT?

A.Thomas P Naidich

B. Robert A Zimmerman

C.James A Brunberg

D.A James Barkovich

E. Patrick D Barnes

AP CASE 1

SECOND SIBLING

WHAT IS THE MOST LIKELY DIAGNOSIS?

A. TORCH Infection

B. Zika Infection

C. Aicardi-Goutieres Syndrome

D. Chorioamnionitis


A. TORCH Infection

B. Zika Infection

C. Aicardi-Goutieres Syndrome

D. Chorioamnionitis

AUTOSOMAL RECESSIVE PSEUDO-TORCH SYNDROME

• Phenotypic overlap with AGS (Aicardi-Goutieres syndrome)

• Failure to determine causative intrauterine infectious agent

• CSF leukocytosis with elevated interferon-alpha, neuropterins

• Hepatic transaminases and thrombocytopenia

Child with right leg weakness

AV CASE 1


A. RF213 mutation (inherited moyamoya)

B. COL3A1 mutation

C. ACTA2 mutation

D. PHACES (unknown mutation)


A. RF213 mutation (inherited moyamoya)

B. COL3A1 mutation

C. ACTA2 mutation

D. PHACES (unknown mutation)

ACTA2 MUTATION

Multisystem smooth muscle dysfunction Straight and narrow intracranial vessels – occlusions and ischemia

No moyamoya collaterals Small corkscrew distal vessels with tiny aneurysms

HX of gastric dysmotility and congenital mydriasis. Several weeks of intermittent R hand numbness, progressively worsening slurred speech

and expressive aphasia

Courtesy of Michelle Silvera

PHACES Posterior fossa malformations

Segmental hemangiomas

Arterial anomalies (narrowing, occlusions,

primitive connections, dilatation,

collaterals, anomalous course, later

aneurysms, etc.)

Cardiac defects

Eye abnormalities

Sternal or ventral defects

WHO WAS THE FIRST FEMALE ASPNR PRESIDENT?

A.Tina Young Poussaint

B. Jill V Hunter

C.Nancy K Rollins

D.Patricia Davis

E. Mary K Edwards-Brown

WHO WAS THE FIRST FEMALE ASPNR PRESIDENT?

A.Tina Young Poussaint

B. Jill V Hunter

C.Nancy K Rollins

D.Patricia Davis

E. Mary K Edwards-Brown

12 year old obese female, headache for one week, nausea/vomiting for one day

ESS CASE 2

A. Pseudotumor cerebri

B. Normal MRI

C. Acute infarction

D. Venous Sinus Thrombosis


A. Pseudotumor cerebri

B. Normal MRI

C. Acute infarction

D. Venous Sinus Thrombosis


PSEUDOTUMOR CEREBRI

• Lumbar puncture:

• Opening pressure: >60cm H20

• Headaches improved

• Discharged on: Methylprednisone taper, Acetazolamide, Gabapentin, Metoclopramide prn

EXCEPT…

• One week after discharge, patient abruptly worsened

• 10/10 occipital headache, blurry vision, confusion, weakness, emesis, enuresis, encopresis, fall and seizure

• Sluggish 3mm pupils, bilateral papilledema, right CN VI palsy, hyporeflexia, unsteady gait, psychomotor slowing, and delayed, slurred speech

• Lumbar puncture:

• Opening pressure: >36cm H20

• Repeat 5 days later, opening pressure: 48cm H20

• All viral, toxicology, and rheumatological laboratory tests normal, aside from mild anemia

Raised papules on extremities

Progressive deterioration with bulbar signs, urinary retention, acutely decreased responsiveness

40lb weight loss since onset of illness (two months)

Over one week, mental status substantially declined

Minimally responsive to sternal rub, only able to

communicate by blinking, progressed to complete

unresponsiveness

A. Inborn error of metabolism

B. Vasculitis

C. Pseudotumor cerebri

D. Toxic exposure


A. Inborn error of metabolism

B. Vasculitis

C. Pseudotumor cerebri

D. Toxic exposure

p-Dichlorobenzene: 2.8mcg/mL (normal = 0, reporting limit 0.020)

2,5-Dichlorophenol (DCB metabolite): 200mg/L (normal = 0, reporting limit 5.0)


LEUKOENCEPHALOPATHY SECONDARY TO

PARADICHLOROBENZENE TOXICITY

• Paradichlorobenzene in many forms of mothballs

• Patient kept many boxes in her poorly ventilated room for >3 years, “reminded her of her grandmother”

• Excessive inhalation or ingestion can cause a progressive leukoencephalopathy with ichthyotic rash and anemia, reports of intracranial hypertension

• Toxin stored & released from fat, acute worsening during catabolic stress (patient decompensated during stress & when NPO)

Twin Girls with Neurocutaneous Symptoms Caused by Mothball Intoxication.

http://www.nejm.org/doi/full/10.1056/NEJMc060329

Hernandez SH, Wiener SW, Smith SW. Case files of the New York City poison center:

paradichlorobenzene-induced leukoencephalopathy. J Med Toxicol. 2010

Jun;6(2):217-29

• 3 yr old female with intermittent vomiting for 2.5 weeks

• Headache

• No fever

• Diagnosed with abusive head trauma at 5mos of age

T2 at 5mos

SP CASE 2

3 years later

Ax Non C+ CT Cor Non C+ CT

Ax T2 FSE

Ax T1 C+

Cor T1 C+

DWI ADC

A. Post-traumatic encephalomalacia

B. Intracranial epidermoid cysts

C. Malignant myxoid glial tumors

D. Abscesses


A. Post-traumatic encephalomalacia

B. Intracranial epidermoid cysts

C. Malignant myxoid glial tumors

D. Abscesses


MALIGNANT MYXOID GLIAL TUMORS

• Very rare

• Meningeal glial rests

• Low grade and high grade histology

BRAIN ABSCESS

T2 DWI ADC T1 C+

INTRACRANIAL EPIDERMOID CYST

T1 C+ DWI ADC

WHAT IS THE NAME OF THE ASPNR BEST PAPER

PRESENTATION AWARD?

A. The Really Great Paper Award

B. The Golden Brain Award

C. The Derek Harwood-Nash Award

D. The ASPNR Gold Medal Award

WHAT IS THE NAME OF THE ASPNR BEST PAPER

PRESENTATION AWARD?

A. The Really Great Paper Award

B. The Golden Brain Award

C. The Derek Harwood-Nash Award

D. The ASPNR Gold Medal Award

Derek Harwood-Nash was one of the fathers of

pediatric neuroradiology and a former President of

the ASNR. In addition to his many tremendous

contributions to our field, he was instrumental in

establishing the ABR CAQ in Neuroradiology. The

ASPNR is proud to honor his memory with this award.

AP CASE 2

Ophthalmoplegia (non-painful)

INTRAOPERATIVE

ULTRASOUND


A. Meningioma

B. Hemangiopericytoma

C. Hemangioendothelioma

D. Schwannoma


A. Meningioma

B. Hemangiopericytoma

C. Hemangioendothelioma

D. Schwannoma

HEMANGIOENDOTHELIOMA (VASCULAR TUMORS)

• Differentiation from hemangioma based on infiltrative growth pattern and predominant Kaposi sarcoma-like content (fascicles of spindle cells)

• Tumor can also have fibrogenic thrombi in the capillaries, hemorrhage, areas of lymphangiomatosis

5 year old with progressive mental decline,

swallowing problems, and weakness

AV CASE 2

MRS, TE=135ms


A. Leigh syndrome

B. LBSL

C. Listeria with rhombencephalitis

D. Late-onset Alexander disease


A. Leigh syndrome

B. LBSL

C. Listeria with rhombencephalitis

D. Late-onset Alexander disease

• Childhood or adolescent onset and slow disease course. Patients develop insidious pyramidal, cerebellar, and dorsal column dysfunction

• Recessive mutations in DARS2, which encodes mitochondrial aspartyl-transfer ribonucleic acid synthetase

MS van der Knaap et al. A new leukoencephalopathy with brainstem and spinal cord

involvement and high lactate. Ann Neurol. 2003

LEUKOENCEPHALOPATHY WITH BRAINSTEM AND SPINAL CORD

INVOLVEMENT AND HIGH LACTATE (LBSL)

Steenweg et al. Neuropediatrics, October, 2012

Revised 2012 MRI criteria

Major criteria

Cerebral white matter (relative sparing of the subcortical white matter)

Dorsal columns and lateral corticospinal tracts of the spinal cord

Pyramids at the level of the medulla or decussation of the medial lemniscus

Minor criteria

Splenium of the corpus callosum

Posterior limb of the internal capsule

Superior and inferior cerebellar peduncles

Intraparenchymal part of the trigeminal nerve

Mesencephalic trigeminal tracts

Anterior spinocerebellar tracts in the medulla oblongata

Cerebellar white matter

LEUKOENCEPHALOPATHY WITH BRAINSTEM AND SPINAL CORD

INVOLVEMENT AND HIGH LACTATE (LBSL)

LEIGH SYNDROME

SURF1 Mutation

Subacute necrotizing

encephalomyelopathy

LISTERIA INFECTION AND RHOMBENCEPHALITIS

Listeria monocytogenes – gram+ bacillus

May lead to abscess

ALEXANDER DISEASE

- GFAP Mutation

- Often large head

- Initially anterior white matter involvement

- Late onset disease often has brainstem

findings

WHO WAS THE FIRST WINNER OF THE DEREK HARWOOD-

NASH AWARD IN PEDIATRIC NEURORADIOLOGY?

A. A James Barkovich, MD

B. Aria Tzika, PhD

C. Charles Fitz, MD

D. William Ball, MD

WHO WAS THE FIRST WINNER OF THE DEREK HARWOOD-

NASH AWARD IN PEDIATRIC NEURORADIOLOGY?

A. A James Barkovich, MD

B. Aria Tzika, PhD

C. Charles Fitz, MD

D. William Ball, MD

Derek Harwood-Nash Outstanding Pediatric Neuroradiology Paper:

Tzika AA, Barnes PD (mentor), Tarbell NJ, Nelson SJ, Scott RM.

“Multivoxel proton spectroscopy of childhood brain tumors",

presentation at ASNR 33rd Annual Meeting, Chicago, IL. 1995

ESS CASE 3

A. Hunter Syndrome (MPS II)

B. Achondroplasia

C. Osteopetrosis

D. Morquio Syndrome (MPS IV)


A. Hunter Syndrome (MPS II)

B. Achondroplasia

C. Osteopetrosis

D. Morquio Syndrome (MPS IV)


23 Months

9 Years

HUNTER SYNDROME MUCOPOLYSACCHARIDOSIS TYPE II

Imaging Findings:

Brain: Enlarged perivascular

spaces, delayed myelination,

white matter ↓T1/↑T2, volume

loss

Spine: Beaking of cervical

vertebrae, foramen magnum

and/or cervical stenosis,

cervical myelomalacia

• Dysostosis with dwarfism, dental anomalies, corneal clouding, no direct CNS involvement (intellectually normal)

MORQUIO SYNDROME MUCOPOLYSACCHARIDOSIS TYPE IV

Spine Imaging Findings: Platyspondyly

with “ovoid” vertebral bodies, odontoid hypoplasia +/- cervical

subluxation, cervical stenosis and

myelomalacia

ACHONDROPLASIA

• Most frequent form of rhizomelic dwarfism

Imaging Findings: Caudal

narrowing of interpediculate

distance, notch-like sacroiliac

groove, exaggerated lumbar

lordosis, cervical stenosis

Fetal CT courtesy of Teresa Victoria

OSTEOPETROSIS

Imaging Findings: Hyperdense bones

AD I - calvarium with sparing of spine

AD II - skull base, spine, pelvis

AR forms - more aggressive with

systemic manifestations

• 7 mos old girl with decreased leg movement since 4 mos of age

• Difficulty with urination and bowel movements

Sag T2 Sag T1 Sag T1 C+ Cor T2

SP CASE 3

Ax T2

DWI ADC

SP CASE 3

A. Plexiform neurofibroma

B. Myxopapillary ependymoma

C. Differentiating neuroblastoma

D. Atypical teratoid rhabdoid tumor


A. Plexiform neurofibroma

B. Myxopapillary ependymoma

C. Differentiating neuroblastoma

D. Atypical teratoid rhabdoid tumor


DIFFERENTIATING NEUROBLASTOMA

• Seven subtypes of neuroblastic tumors according to degree of neuroblastic maturation

MIBG

MYXOPAPILLARY EPENDYMOMA

T1 T1 C+

ATYPICAL TERATOID RHABDOID

T2 FSE

T1 C+

3 weeks later

post excision

PLEXIFORM NEUROFIBROMA

ADC

DWI

STIR

WHO PLAYED NIKOLA TESLA IN THE MYSTERY THRILLER DRAMA “THE

PRESTIGE”?

A. Johnny Depp

B. Robert Downey Jr.

C. David Bowie

D. Justin Timberlake

Question courtesy of Susan Palasis

WHO PLAYED NIKOLA TESLA IN THE MYSTERY THRILLER DRAMA “THE

PRESTIGE”?

A. Johnny Depp

B. Robert Downey Jr.

C. David Bowie

D. Justin Timberlake

pubs.acs.org selvedgeyard.com

Fetal CT courtesy of Teresa Victoria

Sagittal T2

Axial T2

AP CASE 3

Acute Flaccid Paralysis


A. Spinal Cord Infarct

B. Demyelination Lesion

C. Enterovirus myelitis

D. Metastatic disease


A. Spinal Cord Infarct

B. Demyelination Lesion

C. Enterovirus myelitis

D. Metastatic disease

ENTEROVIRUS D68 AND CNS DISEASE

2005 EV-D68 isolated from CSF in “a young adult” with flaccid paralysis1

2008

2014

2012 EV-D68 isolated from nasal swabs of two children w “polio-like” syndrome2

1Khetsuriani et al, MMWR, 2006 2Roux et al, Neurology. 2014;83(10):Supplement P3.335.

0 2 4 6 810

12

14

16

18

20

22

24

26

28

30

32

33 - 73

0

2

4

6

Age (years)

Aff

ecte

d in

div

idu

als

TAKE HOME POINTS

• Enterovirus myelopathy has fairly nonspecific imaging features • T2 prolongation in central gray, cervical

>thoracolumbar, variable nerve root enhancement

• Consistent clinical features help make diagnosis of Acute Flaccid Myelitis

• Motor recovery is usually incomplete

• Enterovirus species are the predominant AFM associate

AV CASE 3


A. Fetal Teratoma

B. NF-1 with optic pathway glioma

C. Pallister-Hall syndrome

D. Orofaciodigital Syndrome


A. Fetal Teratoma

B. NF-1 with optic pathway glioma

C. Pallister-Hall syndrome

D. Orofaciodigital Syndrome

PALLISTER-HALL SYNDROME

Hypothalamic hamartoma (5% of all cases)

Polydactyly - syndactyly

Anal atresia

Renal anomalies

Bifid epiglottis

PALLISTER-HALL SYNDROME

FETAL INTRACRANIAL

TERATOMA

WHAT WAS THE FIRST NEUROIMAGING TECHNIQUE

DEVELOPED? A. Pneumoencephalography

B. Functional MRI

C. Human Circulation Balance

D. Cerebral angiography

WHAT WAS THE FIRST NEUROIMAGING TECHNIQUE

DEVELOPED? A. Pneumoencephalography

B. Functional MRI

C. Human Circulation Balance

D. Cerebral angiography

Italian neuroscientist Angelo Mosso who

invented the 'human circulation balance',

which could non-invasively measure the

redistribution of blood during emotional

and intellectual activity.

Sandrone, S.et al. (2014). Weighing brain activity with the

balance: Angelo Mosso’s original manuscripts come to light.

Brain, 137(2), 621–633.

Former 26 week premature infant, now 5 months old, paraspinal lesion incidentally detected on

Chest CTA

ESS CASE 4

Sag T2 Sag T1

Cor STIR

Ax T2

Post Gad T1 Fat Sat

I123 MIBG/CT Fusion

I-123 MIBG SPECT/CT SCAN CAN BE NEGATIVE IN NEUROBLASTOMA

A. True

B. False

I-123 MIBG SPECT/CT SCAN CAN BE NEGATIVE IN NEUROBLASTOMA

A. True

B. False

I-123 MIBG SPECT/CT FOR NEUROBLASTOMA

Primary Tumor:

• Sensitivity 67-100%

• Specificity 68%

Metastases:

• Sensitivity 79-100%

• Specificity 33-89%

~10% False Negative Rate

Bleeker G, et al. 123I-MIBG scintigraphy and 18F-FDG-PET imaging for diagnosing neuroblastoma. Cochrane Database Syst Rev. 2015 Sep 29;9:CD009263


A. Neuroblastoma

B. Hematoma

C. Hemangioma

D. Neurenteric Cyst


A. Neuroblastoma

B. Hematoma

C. Hemangioma

D. Neurenteric Cyst

INFANTILE CAPILLARY HEMANGIOMA

• Most common soft tissue tumor of infancy

• Incidence has steadily increased over past 35 years, correlating with decreasing gestational age at birth as well as birth weight

Anderson KR, et al. Increasing incidence of infantile hemangiomas (IH) over the past 35 years: Correlation with decreasing gestational age at

birth and birth weight. J Am Acad Dermatol. 2016 Jan;74(1):120-6

GASTRULATION

From Carlson, Human Embryology and Developmental Biology, 2014

NEURENTERIC CYST

• 6yr old with increasing seizures

• Fever

Ax T2 Cor T2

SP CASE 4

A. Hypertrophic olivary degeneration (HOD)

B. Adrenomyeloneuropathy

C. Enterovirus rhombencephalitis

D. Neuromyelitis optica (NMO)


A. Hypertrophic olivary degeneration (HOD)

B. Adrenomyeloneuropathy

C. Enterovirus rhombencephalitis

D. Neuromyelitis optica (NMO)


HOD SECONDARY TO MITOCHONDRIAL DISORDER

• Hypertophy and increased signal in the inferior olivary nucleus

• Palatal tremor

• Rare in children but can be seen following posterior fossa surgery

• Disruption of triangle of Guillain-Mollaret

Goyal M et al. AJNR 2000

ADRENOMYELONEUROPATHY (AMN)

Axial T2

• Form of adrenoleukodystrophy • Long chain fatty acids deposited damage myelin

• Symmetric signal abnormalities along corticospinal tracts

• Atrophy

Courtesy of TAGM Huisman and A Poretti

ENTEROVIRUS RHOMBENCEPHALITIS

Sag T1 Ax T1 Ax T2

• Fever, flaccidity

• Dorsal brainstem, dentate nuclei, cord gray matter

Courtesy of TAGM Huisman and A Poretti

NEUROMYELITIS OPTICA (NMO)

FLAIR Ax T2 Sag T2

• 70% test positive for aquaporin 4

• Involve periventricular structures,

periaqueductal gray, medulla at

obex

• Optic neuritis

IN WHAT YEAR WAS THE FIRST JOINT ASFNR-ASPNR

SYMPOSIUM?

A. 2000

B. 2004

C. 2008

D. 2012

E. 2016

IN WHAT YEAR WAS THE FIRST JOINT ASFNR-ASPNR

SYMPOSIUM?

A. 2000

B. 2004

C. 2008

D. 2012

E. 2016

AP CASE 4

ACUTE RIGHT HEMIPARESIS RECENT BIOPSY OF SKIN LESION

Thanks to Dr Andre Furtado

ONE YEAR LATER


A.Diffuse Axonal Injury

B. Hereditary Hemorrhagic Telangiectasia (HHT)

C. Sturge-Weber

D. Parry-Romberg Syndrome


A.Diffuse Axonal Injury

B. Hereditary Hemorrhagic Telangiectasia (HHT)

C. Sturge-Weber

D. Parry-Romberg Syndrome

AJNR 36:1355-61, Jul 2015

PARRY-ROMBERG SYNDROME

• Rare, self-limiting progressive hemiatrophy of the face (but brain abnormalities can present first)

• Skin lesion = Scleroderma

• Intracranial findings: parenchymal calcifications, hemorrhage, white matter lesions, atrophy

• Etiology unknown (autoimmune?)

Intermittent exotropia, headache, and

papilledema

T2 T1 Gad T1

AV CASE 4

SWI Magnitude DWI ADC SWI Phase

T2

WHAT IS YOUR DIAGNOSIS?

A. Choroid plexus carcinoma

B. Supratentorial PNET

C. Meningioma

D. Cavernous Malformation

WHAT IS YOUR DIAGNOSIS?

A. Choroid plexus carcinoma

B. Supratentorial PNET

C. Meningioma

D. Cavernous Malformation

GIANT CAVERNOUS MALFORMATION

(CAVERNOMA)

T2 T1 Gad T1

INTRAVENTRICULAR MENINGIOMA

T2 T1 Post CT

SUPRATENTORIAL PNET

T2 DWI T1 Post T2* GRE

CHOROID PLEXUS CARCINOMA

T2 DWI

T1 Post FLAIR

WHAT WAS YOUR FAVORITE SESSION AT THE 2016 ASNR

ANNUAL MEETING?

A. Session 2A

B. Lunch

C. Session 3D

D. The Annual Business Meeting

E. THE ASPNR INTERESTING CASE SESSION

WHAT WAS YOUR FAVORITE SESSION AT THE 2016 ASNR

ANNUAL MEETING?

A. Session 2A

B. Lunch

C. Session 3D

D. The Annual Business Meeting

E. THE ASPNR INTERESTING CASE SESSION

www.aspnr.org

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ASPNR INTERESTING CASE SESSION...ASPNR INTERESTING CASE SESSION ASNR 54 th Annual Meeting May 23, 2016 Erin Simon Schwartz, MD, President Susan Palasis, MD, Vice-President Ashok Panigrahy,