Posts

Aqueductal Web Causing Obstructive Hydrocephalus in a 50-Year-Old Patient

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  In this case presentation, we review the imaging findings of a 50-year-old male presenting with balance issues, visual disturbances, and general fatigue. While aqueductal stenosis is often associated with pediatric populations, adult-onset presentation due to an ependymal web is a critical diagnostic entity to recognize. Check out the full breakdown and see the high-resolution sequences in the video below: Key Imaging Findings Ventriculomegaly: The ventricular system is widened supratentorially, with an Evans' index of 0.36 . The temporal horns and cerebral sulci remain within normal limits. Secondary Signs of Hydrocephalus: Notable upward expansion of the corpus callosum and very faint transependymal leakage (interstitial edema). The Web: High-resolution multiplanar reconstruction (MPR) and sagittal FLAIR sequences reveal a thin membrane localized to the lower one-third of the aqueduct . Caliber Mismatch: The aqueduct measures approximately 4 mm at the level of the superior ...
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Dual Pathology in Epilepsy – Mesial Temporal Sclerosis, Frontal Contusions, and an Incidental Pontine Finding

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  When evaluating neuroimaging for epilepsy, finding a clear culprit is always a breakthrough. But what happens when the images reveal a more complex story—a "double whammy" of potential epileptogenic foci? In the upcoming video on Radiant Pixels , we dive into a fascinating, longitudinal case of an epilepsy patient followed over a 12-year period (from age 30 to 42). This case beautifully illustrates classic mesial temporal sclerosis (MTS) while presenting an intriguing secondary structural pathology that poses a classic chicken-and-egg dilemma. The Primary Suspect: Mesial Temporal Sclerosis (MTS) The journey begins with a look back at the patient's scans from 12 years ago. On the coronal sequences—specifically using an inversion recovery sequence highly sensitive to anatomical structures—we see the definitive hallmarks of mesial temporal sclerosis : Volume Loss: Clear, asymmetric atrophy of the left hippocampus. Hyperintensity: Markedly increased signal intensity on t...
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New Case on Radiant Pixels: Unpacking a Classic Developmental Venous Anomaly (DVA)

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  A new case presentation is now live on the Radiant Pixels YouTube channel. In this session, we walk through an excellent example of a normal vascular anatomical variant that frequently catches the eye during routine scans: a Developmental Venous Anomaly (DVA) located in the cerebellum. When evaluating a suspected DVA, a systematic, multi-sequence approach is essential to confirm the diagnosis and rule out complications. Here is a brief summary of the key diagnostic imaging points highlighted in the video: Non-Enhanced CT: The anomaly may initially present as a subtle high-density structure, prompting further MR investigation. Standard MRI (T1, T2, FLAIR): Look for a tubular structure exhibiting the classic "caput medusae" configuration—a cluster of small branching vessels. These typically show a low signal on T2 and FLAIR. Crucially, the surrounding brain parenchyma should appear anatomically normal, lacking any signs of gliosis, volume loss, or old infarctions. Time-of-...
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New Video on Radiant Pixels: Intracanalicular Vestibular Schwannoma & The "Monkey Face" Mnemonic

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  Welcome back to the blog. Following up on my previous posts, Monkey looking at cerebellum and Small  Vestibular Schwannoma , I have just published a new companion video on the Radiant Pixels YouTube channel that brings these concepts to life. If you are looking to sharpen your diagnostic skills regarding internal acoustic canal pathology and anatomy, this case presentation is for you. What to Expect in the New Video In this latest upload, I walk through a classic presentation of a 75-year-old patient experiencing left-sided hearing loss. We review the imaging step-by-step, starting with the thin-slice T2 sequences that are highly sensitive for evaluating the internal acoustic canals, all the way through to the contrast-enhanced T1 coronal slices. Key highlights of the case include: Identifying a normal vascular AICA-loop at the level of the porus acusticus and understanding when to note it for the clinician. Locating and measuring a small 5 mm by 3 mm dark structure plugge...
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Evolution of Hemorrhagic Infarctions on MRI

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  Evolution of Hemorrhagic Infarctions on MRI Welcome to another intriguing radiology case study. In our latest release on the Radiant Pixels YouTube channel, we dive into a comparative MRI analysis of an 80-year-old patient, examining scans taken five months apart. This case provides a fantastic look at the evolution of subacute infarctions and the often-perplexing behavior of contrast-enhancing areas over time. The Initial Findings and the Mystery Enhancement The baseline exam reveals distinct areas of tissue loss and gliosis, accompanied by contrast enhancement in the medial parts of the right occipital lobe. We also observe similar, smaller contrast-enhancing areas in the right lateral frontal lobe, specifically at the level of the inferior frontal gyrus. The initial radiological report strongly suggested these locations were indicative of subacute to old infarctions within the posterior cerebral artery territory. However, the persistent contrast enhancement presented a specif...
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New Video Case on Radiat Pixels: Radiation-Induced Cavernous Malformation

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  I have just uploaded a new video case to the   Radiat Pixels   YouTube channel, highlighting a fascinating and critical late complication of oncological treatment that every radiologist should keep on their radar. Case Overview In this week's video, we review the neuroimaging follow-up of a 33-year-old patient. The clinical timeline is key here: this patient underwent surgical resection and subsequent therapy for a medulloblastoma during childhood. Crucially, a follow-up control exam performed when the patient was 19 years old was completely clear, showing no signs of tumor recurrence and no vascular abnormalities. Now, at 33 years of age, the latest follow-up imaging reveals the distinct development of a new cavernous malformation. The Core Teaching Point The primary takeaway from this case is a vital reminder for long-term follow-up imaging:   Cavernomas can be radiation-induced. Radiation-induced cavernous malformations (RICMs) are a well-documented, delayed com...
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MVNT - Multinodular and Vacuolating Neuronal Tumour

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  New on Radiant Pixels : Spotting an MVNT in a Suspected Epilepsy Case Welcome to   Radiant Pixels , my brand-new YouTube channel dedicated to fascinating radiological cases and imaging insights! In our latest video, we are diving deep into a compelling neuroimaging workup of an adult patient being investigated for a possible epilepsy focus. The Case Breakdown Initial investigations started with a standard CT scan, which was entirely negative. However, the MRI painted a much more detailed and intriguing picture. During the read, we isolated a very specific lesion with the following characteristics: Location:   Juxtacortically adjacent to the right gyrus cinguli. Morphology:   A distinct, micro-bubbly and nodular appearance. Edema:   Absolutely no perifocal edema present. Vascularity & Enhancement:   No pathological vessels and zero contrast enhancement. The Diagnosis For radiologists, these specific imaging hallmarks—particularly the juxtacortical bubb...
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