BRAIN

REVIEW

Intraparenchymal hematoma

• Trauma, HTN, stroke, venous thrombosis, amyloid, vascular lesion, neoplasm, hypocoagulability

• With SAH or SDH, reduce to trauma, vascular lesion, amyloid

• Trauma in characteristic locations

Thrombus in wall

• DDX with IPH--blood evolution

• Slow flow versus thrombus conundrum

• Role of PC-MRA

• DDX of wall hematomas– FMD, Marfan, homocystinuria, Ehlers

Danlos, trauma, cystic medial necrosis

Teratoma

• Except at sacrococcygeal, more common than intraspinal

• Suprasellar, peripineal

• AFP

• DDX rhabdoid tumors, PNETS

Calcified peripheral mass

• Supratentorial ependymoma, PNET, ca met, cysticercosis, granuloma, cavernomas

• Pork tapeworm-passed to stool--contaminate water--ova in GI-bloodstream-to CNS– Parenchyma, IV, SAS– Sxs most common when calcified--elicit rxn--

no scolex

CPM

• Osmotic demyelination

• ETOH, malnourished, new interns

• Deep gray, capsular, cerebellum can be involved

• ? Marchiafava bignami

Chordoma

• Notochord remnants, physaliferous cells

• Very bright on T2W---suck

• DDX myeloma, plasmacytoma, chondroid lesion, met, mucocele, pit adenoma

• Ecchordoses--non-neoplastic remnants in clivus

• 6 nerve palsy--dorello’s canal

Schizencephaly

• Lined by polymicrogyria

• Injury to radial glial fibers and germinal matrix--ischemic

• 25-50% SOD

• Dimple at edge of ependyma

BG Calcification

• Metabolic, infectious (HIV), degenerative, toxic (lead)

• Cytochrome C--Leigh’s (pyruvate dehydrogenase, carboxylase)

• Fahr’s ds--mvmt disorder, neuropsych ds, extensive ca++

SATCHMOE

• CP: cause of bright signal on T1WI

• Complication: pseudoaneurysm

• Bimodal age (5-10, 40-60) with less calcification in older group

• More squamous variety--solid, grow into 3rd vent

• Hypothalamic dysfn, hypopit

Microadenoma

• DDX pituitary lesions

• Value of bolus study

• Acromegaly vs cushingoid versus infertility

• Size criteria

• Upward bowing, stalk deviation