equus Posted October 13, 2011 Report Share Posted October 13, 2011 For my undergraduate neuroscience class, I'm supposed to analyze this MRI of a brain and make tentative diagnoses of neurological disorders based on it. I'm having trouble coming up with answers though, so I was wondering if anyone could help me out? It's not being marked, but I'm really interested in this type of stuff. Edit: The patient is female, in her early 20s. That's all the info I was given. Link to comment Share on other sites More sharing options...
tooty Posted October 13, 2011 Report Share Posted October 13, 2011 what is the clinical context of this patient?? Link to comment Share on other sites More sharing options...
lost__in__space Posted October 13, 2011 Report Share Posted October 13, 2011 This person has enlarged ventricles, indicative of Alzheimer's. It would help if you knew the age of the person (as some people naturally have large ventricles but if this person was 60-80 that'd be a good guess). This is what my Masters research is all about Link to comment Share on other sites More sharing options...
A-Stark Posted October 13, 2011 Report Share Posted October 13, 2011 I'm not sure you can diagnose diffuse atrophy based on this single sagittal slice. The 4th ventricle doesn't look especially enlarged. In any case, Alzheimer's can only be definitively diagnosed post-mortem, and there are lots of reasons for big ventricles. This could be a case of aqueductal stenosis, for example. This looks like a T1 image? Link to comment Share on other sites More sharing options...
thebouque Posted October 13, 2011 Report Share Posted October 13, 2011 This person has enlarged ventricles, indicative of Alzheimer's. It would help if you knew the age of the person (as some people naturally have large ventricles but if this person was 60-80 that'd be a good guess). This is what my Masters research is all about There is a big differential to enlarged ventricles, from normal pressure hydrocephalus to an obstruction of the choroid plexus and dementias as you pointed out. Probable alzheimer is a clinical diagnosis (look it up in your DSM IV), however, as someone pointed out, definitive alzheimer is a pathological diagnosis. Link to comment Share on other sites More sharing options...
lost__in__space Posted October 13, 2011 Report Share Posted October 13, 2011 I'm not sure you can diagnose diffuse atrophy based on this single sagittal slice. The 4th ventricle doesn't look especially enlarged. In any case, Alzheimer's can only be definitively diagnosed post-mortem, and there are lots of reasons for big ventricles. This could be a case of aqueductal stenosis, for example. This looks like a T1 image? For Alzheimer's, the lateral ventricles are affected, the third and fourth aren't normally looked at on MRI. And yes indeedy, AD technically is only "officially" diagnosed post-mortem but you can put them in a "probable AD" category, like big Alzheimer studies do (such as ADNI). And yes this is a T1-weighted image. Link to comment Share on other sites More sharing options...
Jochi1543 Posted October 13, 2011 Report Share Posted October 13, 2011 I cannot evaluate this image as it is missing adequate arrow signs. Link to comment Share on other sites More sharing options...
Ninjaface Posted October 13, 2011 Report Share Posted October 13, 2011 Pituitary adenoma? Looks a little on the large side of things. Can't really say without a clinical context though. Link to comment Share on other sites More sharing options...
thebouque Posted October 13, 2011 Report Share Posted October 13, 2011 Well OP, what chapter are you studying right now in your undergrad neuro course? Link to comment Share on other sites More sharing options...
Erk Posted October 14, 2011 Report Share Posted October 14, 2011 Hantavirus. Link to comment Share on other sites More sharing options...
Dino Posted November 18, 2011 Report Share Posted November 18, 2011 Anything larger? Link to comment Share on other sites More sharing options...
Racerfiveo Posted November 19, 2011 Report Share Posted November 19, 2011 Acute subdural hematoma over the frontal parietal region with minimal adjacent sulcal effacement. Link to comment Share on other sites More sharing options...
A-Stark Posted November 19, 2011 Report Share Posted November 19, 2011 Not something you can really evaluate on a midline sagittal MRI cut. Link to comment Share on other sites More sharing options...
Larrivee Posted November 19, 2011 Report Share Posted November 19, 2011 funny looking nose Link to comment Share on other sites More sharing options...
Racerfiveo Posted November 20, 2011 Report Share Posted November 20, 2011 Not something you can really evaluate on a midline sagittal MRI cut. Not a great image to give a non-radiologist let alone a person without an MD. I have feeling this this would not have been picked up by the very people giving the assignment! Link to comment Share on other sites More sharing options...
NLengr Posted November 20, 2011 Report Share Posted November 20, 2011 I cannot evaluate this image as it is missing adequate arrow signs. I use the positive arrow sign all the time. I say it's prostate cancer. Can we get a rads resident to give it a guess. I am interested now, even though the brain isn't my field. Link to comment Share on other sites More sharing options...
BrendanJ Posted November 30, 2011 Report Share Posted November 30, 2011 Acute subdural hematoma over the frontal parietal region with minimal adjacent sulcal effacement. think about your image orientation and what normal anatomic structure should be where you are drawing attention to . . . Link to comment Share on other sites More sharing options...
Racerfiveo Posted November 30, 2011 Report Share Posted November 30, 2011 Differential is superior sagittal sinus thrombosis. You would need an MRV to clarify. Link to comment Share on other sites More sharing options...
BrendanJ Posted November 30, 2011 Report Share Posted November 30, 2011 Haha that's what I'm talkin bout! Call the referring clinician back and ask if this 20 year old female is pregnant with a headache haha Link to comment Share on other sites More sharing options...
PhoenixFlare500 Posted November 30, 2011 Report Share Posted November 30, 2011 As I'm just starting neurology, I consider myself an expert on reading these MRIs already. My diagnosis: Your patient's been cut in half. Also lost all color. This is a bad sign. He probably has cancer. Or Lupus. But really, to me something looks funny just above the parietal region, maybe a subdural hemorrhage or something. And seriously we just started our neuro block so I have no idea what I'm talking about. Link to comment Share on other sites More sharing options...
jmlconkl Posted November 30, 2011 Report Share Posted November 30, 2011 not so sure. acute blood should be bright on T1-weighted images (like this one), and the sulci look pretty darn normal (can see nice black CSF between adjacent gyri). i see the structure you are worried about but keep in mind this is very close to midline, could just be part of the superior sagittal sinus. Acute subdural hematoma over the frontal parietal region with minimal adjacent sulcal effacement. Link to comment Share on other sites More sharing options...
Racerfiveo Posted December 1, 2011 Report Share Posted December 1, 2011 Acute blood is isointense not hyperintense. Like I said earlier. Single sagittal image is hard to definitively diagnose. It might or might not be subdural hematoma or venous thrombosis. The reason i first chose hematoma is because the image slice appears slightly para sagittal without clear visualization of the straight or inferior sagittal sinuses although I do see the aqueduct of sylvius. The ventricles are enlarged for a person 20 years of age. A discrete mass is not seen in the 3rd ventricle or at the foramen Monroe but there is a mass like area in the ventricle. A few things that need clarification with additional images. We need an answer from the OP. We can opine much at this point but additional images will allow for a diagnosis. Interesting case nonetheless. Link to comment Share on other sites More sharing options...
jmlconkl Posted December 1, 2011 Report Share Posted December 1, 2011 my bad, you are right about acute blood on t1 and I like your differential. hopefully OP posts answer when given to his class. Acute blood is isointense not hyperintense. Like I said earlier. Single sagittal image is hard to definitively diagnose. It might or might not be subdural hematoma or venous thrombosis. The reason i first chose hematoma is because the image slice appears slightly para sagittal without clear visualization of the straight or inferior sagittal sinuses although I do see the aqueduct of sylvius. The ventricles are enlarged for a person 20 years of age. A discrete mass is not seen in the 3rd ventricle or at the foramen Monroe but there is a mass like area in the ventricle. A few things that need clarification with additional images. We need an answer from the OP. We can opine much at this point but additional images will allow for a diagnosis. Interesting case nonetheless. Link to comment Share on other sites More sharing options...
bobinz Posted January 7, 2012 Report Share Posted January 7, 2012 Empty Sella Syndrome Link to comment Share on other sites More sharing options...
aaronjw Posted January 11, 2012 Report Share Posted January 11, 2012 Go DIAF. Serratusly. Please tell me you werent using an acronym to tell this person to go die in a fire? Link to comment Share on other sites More sharing options...
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