Radiology MRI

Non contrast CT of the 96 years old patient shows large subacute Subdural Hematoma (SDH). Note significant middle line shift. Also observe density of this hematoma gradually increasing from anterior to posterior due to sediment. This SDH is evident, however sometimes the isointensity to the brain can obscure even large hematomas.

CT shows contrast enhancing soft tissue mass parietal and occipital on the left side. Bone window images show destruction and deformity of the occipital bone due to biopsy proven Neurofibroma. 3D reconstructions of the CT Angio study show relation of the Neurofibroma with the transverse and sigmoid sinus. There is no obstruction of the venous blood flow occipitally.

Note occlusion of the 3 cm long part of proximal left subclavian artery that is proximal to the left vertebral artery. The flow in the distal left subclavian artery is from the left vertebral artery - Subclavian Steal . As a consequence there is reverse flow in the left vertebral artery (confirmed by Duplex). Additionally there is stenosis in the origin of both vertebral arteries and in the right proximal subclavian artery (last image).

The above screen-grab is a result of my Google Image search for MRI in Parkinson with selection to "show similar images" (that is to the first image above). Rather surprising and unexpected result! If computed assisted radiology is going to function like Google Image Search engine - than we are long way before computers are replacing humans at the radiology workstations.

This patient presented with right sided hemianopsia. Non contrast CT shows well demarcated occipital infarct on the left side. Infarct was not clear at the initial scan. Therefore it is important to look especially in the clinically suspected territory of the brain. At the above simplified schema note physiological correlation of the optic pathways and infarct location. In this case the black striped area corresponds with left sided occipital infarct and right sided hemianopsia.

Unenhanced CT of the 93 yrs old patient showing extensive acute right Middle Cerebral Artery (MCA) infarct. At first look infarct may not seem obvious. However note decreased amount of sulci that is most striking compared to the normal left side in this patient with normal for age cortical atrophy. Note decreased attenuation of the MCA territory on the right side as well as diminished delineation of the grey-white matter differentiation.