Radiology MRI

Waiting for snow in December to improve photography light. Low light Lichen  Fern Submarine Loving Our lake Watching Looking Tree Monster!

T2 images show bilateral optic nerve atrophy with bilateral distention of the perioptic subarachnoid space, flattening of the posterior sclera, intraocular protrusion of prelaminar optic nerve (arrow on last image), elongated and tortuous optic nerves, partially empty sella due to enlargement of the suprasellar cistern. Role of MRI is to assist in diagnosis - not to make it. It's also important to exclude sinus thrombosis. Interesting article: Lim MJ - Magnetic Resonance Imaging Changes in Idiopathic Intracranial Hypertension in Children

T1 with Gd shows cystic lesion in the cerebellum with strongly enhancing mural nodule (Hemangioblastoma). Another cystic lesion is seen in medulla oblongata, that also contains strongly enhancing mural nodule (arrow). This patient is known with Von Hippel Lindau syndrome and is known with multiple Hemangioblastomas also in the spinal cord and has previously been operated in the posterior fossa. Cystic wall rarely enhances - important in differential diagnosis.

December brought some frost and leaves are down. But first was fog. That's Alf in the web. ;-) Then came frost. Most of the photos are by my talented wife Anna @Myszuwa

With the first frost we see more patients coming after fall trauma due to gliding on ice. It is important to evaluate the Atlanto Occipital Articulation on CT. Look carefully at the relation of basion (lowest tip of clivus) and tip of dens. The distance between basion and superior tip of dens (Basion Dens Interval) should not be grater than 12mm. Evaluate the ligaments for continuity or possible surrounding hematoma. The image above shows those important ligamentous structures (arrows from left to right): 1. Anterior Longitudinal Ligament 2. Atlanto-Occipital Ligament 3. Apical Odontoid Ligament 4. Tectorial Membrane. In case you suspect pathology - make MRI. Interesting articles: 1. Lustrin - Pediatric Cervical Spine: Normal Anatomy,  Variants, and Trauma 2. Malanga - Cervical Spine Sprain/Strain Injuries