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Seyed Kazem Malakouti, MD
MRI and Mental disorders
Seyed Kazem Malakouti, MDFaculty of
Iran University of Medical Sciences
Seyed Kazem Malakouti, MD
• intra-axial : in brain or spinal cord tissue• astrocytoma and oligodendroglioma are intra-axial• brain tissue, ventricles
• extra-axial: extrinsic to brain • meningioma and Schwannoma • Epidural, subdural, subarachnoid
Seyed Kazem Malakouti, MD
• Supra tentorial• Infra tentorial• Posterior fossa
Seyed Kazem Malakouti, MD
Seyed Kazem Malakouti, MD
Seyed Kazem Malakouti, MD
Pituitary tumor
Seyed Kazem Malakouti, MD
Pituitary tumor
Seyed Kazem Malakouti, MD
• Virchow & robin space Perivascular space Penetration of subarachnoid into deep brain with capillaries• Small foci isointense to CSF
Seyed Kazem Malakouti, MD
• Hypocampal region in AD
Seyed Kazem Malakouti, MD
Seyed Kazem Malakouti, MD
Normal pressure hydrocephalus
• Gait• Apraxia• Dementia• incontinence
Seyed Kazem Malakouti, MD
Bilateral Pallidal necrosis
• CT scan & MRI slice• CO poisoning
Seyed Kazem Malakouti, MD
Huntington disease
• 64 y.o male• Caudate atrophy• Pallidus atrophy
Seyed Kazem Malakouti, MD
Normal hyperintensity of posterior limb of internal capsule
• 30 y.o• Intensity similar to
cortex in T2• Round, oval hyperinsity
area• Bilateral lesion• Ependemitis granularis,
normal view of hyperintesities : caps
Seyed Kazem Malakouti, MD
Wilson disease
• Globus Pallidus hyperintensity
• Brain stem hyperintensity
Seyed Kazem Malakouti, MD
Seyed Kazem Malakouti, MD
• 36-year-old woman• dysarthria, • axial tremor• ataxia
Seyed Kazem Malakouti, MD
WD– severe dysarthria– dysphonia, – akathisia, – truncal appendicular – tremor, – left hemiparesis– dystonia.
• Serum ceruloplasmin was markedly decreased at 10 mg/dL (normal 18 to 55 mg/dL)
Seyed Kazem Malakouti, MD
WD
• “face of the giant panda” sign that is characteristic of Wilson’s disease
• T2-weighted axial MRI demonstrates the “face of the giant panda” in the midbrain with high signal in tegmentum and normal red nuclei (arrow)
Seyed Kazem Malakouti, MD
• T2-weighted axial MRI reveals the
“face of the miniature panda” in pons with hypointensity of central tegmental tracts (arrow) with hyperintensity of aqueductal opening to fourth ventricle
Seyed Kazem Malakouti, MD
• acoustic schwannoma: ~80% of CPA masses (most common by far)
• meningioma: ~10% of CPA masses (second most common)
• trigeminal schwannoma• facial nerve
schwannoma• ependymoma• metastasis
Seyed Kazem Malakouti, MD
Seyed Kazem Malakouti, MD
• Tegmentum – Periaqueductal gray (PAG) – The periaqueductal gray is the gray matter around the cerebral aqueduct that deals with pain.
• Substantia nigra and red nucleus – There are important components of the sensorimotor system, and play a role in Parkinson’s and dopamine.
Seyed Kazem Malakouti, MD
Seyed Kazem Malakouti, MD
Seyed Kazem Malakouti, MD
• Tectum – The tectum is the dorsal surface of the midbrain. It is responsible for auditory/visual reflexes, like jumping when someone slams a door.
• Tectum includes:– Superior colliculi – The top part, which controls the
visual reflexes
– Interior colliculi - The bottom part, which control the auditory reflexes
Seyed Kazem Malakouti, MD
Werniche encephalopathy
• 33 y.o• Tectum: white arrow, periaquedutal parnchma• Mamillary bodies: white
arrowheads
Seyed Kazem Malakouti, MD
Werniche encephalopaty
• 53 yo• Hyperintensity of
mamillary bodies
Seyed Kazem Malakouti, MD
• FLAIR sequence MRI image at the level of the midbrain increased signal in the periaqueductal gray matter
Seyed Kazem Malakouti, MD
• Axial FLAIR images show abnormal high signal intensity in the mammillary bodies (white arrows)