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PART 17: Neurologic Disorders
SECTION 1   Diagnosis of Neurologic Disorders

e44  Atlas of Neuroimaging
Andre Furtado / William P. Dillon

Figure e44-1  Limbic encephalitis (Chap. 101) Coronal (A, B), axial fluid-attenuated inversion recovery (FLAIR) (C,
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Figure e44-2  CNS tuberculosis (Chap. 165)

Axial T2-weighted MRI (A) demonstrates multiple lesions (arrows) with peripheral high signal and central low signal, located predominantly in the cortex and subcortical...

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Figure e44-3  Neurosyphilis (Chap. 169)

Case I

Axial T2-weighted MR images (A, B) demonstrate well-defined areas of abnormal high signal in the basal...

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Figure e44-4  Neurosyphilis (Chap. 169)

Case II

Axial T2-weighted MRI (A) demonstrates a dural-based, peripherally hyperintense and centrally hypointense lesion located lateral to the left frontal lobe (arrow).

Axial (B) and coronal (C) T1-weighted MR images postgadolinium demonstrate peripheral enhancement of the lesion (

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Figure e44-5  Histoplasmosis of the pons (Chap. 199)

Axial FLAIR (A) and T2-weighted (B) MR images demonstrate a low signal mass in the right pons (arrows) with...

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Figure e44-6  Coccidiomycosis meningitis (Chap. 200)

Axial postcontrast CT (A) and axial (B) and coronal (C) T1-weighted MR images postgadolinium demonstrate enhancement of the perimesencephalic cisterns (arrows), as well as the sylvian and interhemispheric...

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Figure e44-7  Candidiasis in a newborn (Chap. 203)

Axial T2-weighted MR image (A) demonstrates multiple punctate foci of low signal diffusely distributed in the brain parenchyma (arrowhead).

Axial T1-weighted...

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Figure e44-8  CNS aspergillosis (Chap. 204)

Axial FLAIR MR images (A, B) demonstrate multiple areas of abnormal high signal in the basal ganglia as well as cortex and subcortical white...

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Figure e44-9  Invasive sinonasal aspergillosis (Chap. 204)

Axial T2-weighted MR image (A) demonstrates an irregularly shaped low signal lesion involving the left orbital apex (arrow).

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Figure e44-10  Behçet's disease (Chap. 327)

Axial FLAIR MRI demonstrates abnormal high signal involving the anterior pons (arrow); following gadolinium administration, the lesion was nonenhancing (not shown). Brainstem lesions are typical of Behçet's disease, caused primarily by vasculitis and in some cases demyelinating...

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Figure e44-11  Neurosarcoid (Chap. 329)

Case I

Coronal (A) and axial (B) T1-weighted images postgadolinium with fat suppression demonstrate a homogeneously enhancing well-circumscribed mass centered in the left Meckel's cave (

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Figure e44-12  Neurosarcoid (Chap. 329)

Case II

Axial (A, B) and sagittal (C) T1-weighted images postgadolinium with fat suppression demonstrate a homogeneously enhancing mass involving the hypothalamus and the pituitary stalk (

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Figure e44-13  Neurosarcoid (Chap. 329)

Case III

Axial FLAIR images (A–E) demonstrate abnormal high signal and slight expansion in the midbrain, dorsal pons, and pineal region (

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Figure e44-14  Neurosarcoid (Chap. 329)

Case IV

Axial T2-weighted images (A–D) demonstrate numerous areas of abnormal hyperintensity involving the corpus callosum, left internal capsule and globus...

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Figure e44-15  Histiocytosis (Chap. 340)

Sagittal T1-weighted image (A) demonstrates enlargement of the pituitary stalk (arrow) and absence of the posterior pituitary intrinsic T1 hyperintensity (arrowhead).

Sagittal and coronal T1-weighted images postgadolinium (B, C) demonstrate enhancement of the pituitary stalk and infundibulum (

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Figure e44-16  Middle cerebral artery stenosis (Chap. 370)

Time-of-flight (TOF) MR angiography (MRA) (A, B) reveals narrowing within the left M1 segment that is likely secondary to atherosclerosis (

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Figure e44-17  Lacunar infarction (Chap. 370)

Axial noncontrast CT (A) demonstrates abnormal hypodensity involving the left anterior putamen and anterior limb of internal capsule with ex-vacuo dilatation of the adjacent frontal horn of the...

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Figure e44-18  Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) (Chap. 370)

Axial T2-weighted MR images (A, B) demonstrate multiple patchy areas of abnormal high signal in the...

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Figure e44-19  CNS vasculitis (Chap. 370)

Axial noncontrast CT (A) demonstrates a large hyperdense intraparenchymal hematoma surrounded by hypodense vasogenic edema in the right parietal lobe.

Axial T2-weighted MRI (

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Figure e44-20  Superior sagittal sinus thrombosis (Chap. 370)

Noncontrast CT of the head (A) demonstrates increased density in the superior sagittal sinus, suggestive of thrombosis (arrow), and small linear...

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Figure e44-21  Multiple system atrophy (Chap. 372)

Axial T2-weighted MR image (A) reveals symmetric poorly circumscribed abnormal high signal in the middle cerebellar peduncles bilaterally (arrowheads).

Sagittal T1-weighted MR image (B) demonstrates pontine atrophy and enlarged cerebellar fissures as a result of cerebellar atrophy (

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Figure e44-22  Huntington's disease (Chap. 372)

Axial noncontrast CT (A) demonstrates symmetric bilateral severe atrophy involving the caudate nuclei, putamen, and globus pallidi bilaterally with consequent enlargement of the frontal horns of...

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Figure e44-23  Bell's palsy (Chap. 376)

Axial T1-weighted images postgadolinium with fat suppression (A–C) demonstrate diffuse smooth linear enhancement along the left facial nerve, involving the second and third segments (genu,...

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Figure e44-24  Spinal cord infarction (Chap. 377)

Sagittal T2-weighted MR image of the lumbar spine (A) demonstrates poorly defined areas of abnormal high signal in the conus medullaris and mild cord expansion (

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Figure e44-25  Acute transverse myelitis (Chap. 377)

Sagittal T2-weighted MR image (A) demonstrates abnormal high signal in the cervical cord extending from C1 to T1 with associated cord expansion (arrows)....

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Figure e44-26  Acute disseminated encephalomyelitis (ADEM) (Chap. 380)

Axial T2-weighted (A) and coronal FLAIR (B) images demonstrate abnormal areas of high signal involving predominantly...

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Figure e44-27  Baló's concentric sclerosis (a variant of multiple sclerosis) (Chap. 380)

Coronal FLAIR MRI (A) demonstrates multiple areas of abnormal high signal in the supratentorial white matter bilaterally. The lesions are ovoid in...

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Figure e44-28  Hashimoto's encephalopathy (Chap. 381)

Axial FLAIR (A) demonstrates focal area of abnormal high signal involving the gray and white matter in the left frontal lobe. There is also a small area of abnormal high signal in the...

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Figure e44-29  Brachial plexopathy (Chap. 384)

Axial (A), sagittal (B), and coronal (C, D) short tau inversion recov...

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Figure e44-30  Anterior dens dislocation

Sagittal CT demonstrates the tip of the dens below the anterior arch of C2 (arrow), indicating anterior dislocation.

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Figure e44-31  CT facet fracture

Axial CT demonstrates fracture line along the C2 facet (arrow).

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Figure e44-32  Compression fracture

Sagittal T2-weighted MRI demonstrates compression fracture of C7 (*) and high signal within the spinous processes of C6-C7 (arrows) and to lesser degree C5-C6. This is suggestive of interspinous ligament injury. Note the pad under the patient's neck to maintain neck alignment during the scanning...

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Figure e44-33  Epidural hematoma

Axial noncontrast CT (A) demonstrates a high-density epidural collection in the cervical spine (*), which is consistent with acute hemorrhage. Also noted is mass effect on the spinal cord (

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Figure e44-34  Retropharyngeal soft tissue mass

Sagittal T1-weighted MRI demonstrates a hyperflexion fracture with retropulsion of the posterior wall in the canal at C5 and C6 (arrow). There is also a large retropharyngeal hematoma (*). The distance from the posterior wall of the...

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Figure e44-35  Jefferson fracture

Axial CT demonstrates four fracture lines (arrows) separating C1 in four parts. Jefferson fracture is usually caused by axial impact to the head such as diving in shallow water.

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Figure e44-36  Ligament injury after trauma

Coronal CT reconstruction demonstrates abnormal asymmetry between the dens and the lateral masses of C1 indicating transverse ligament rupture.

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Figure e44-37  Odontoid fracture

Sagittal CT demonstrates disruption of the main reference cervical lines. 1: Anterior vertebral body line; 2: Posterior vertebral body line; 3: Spinolaminar line.

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Figure e44-38  Pathologic fracture

Sagittal T1-weighted MRI (A) demonstrates wedge-shaped T6 vertebral body (arrow). Sagittal postcontrast T1-weighted MRI (B) depicts tumor extension into the epidural space and the involvement of the posterior arch (*), which are highly suggestive of metastatic or primary bone...

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Figure e44-39  Sacral insufficiency fracture

Axial T2-weighted MRI (A) and T1-weighted MRI (B) demonstrate symmetric high T2 and low T1 signal involving the sacral alae longitudinally (arrows).

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Figure e44-40  Subdural hematoma

Sagittal T2-weighted MRI (A) and axial noncontrast T1-weighted MRI (B) demonstrate subdural collection in the lumbosacral region (**). Note that the epidural fat is compressed but not involved (

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Figure e44-41  Teardrop fracture

Sagittal CT (A) demonstrates fracture line separating the antero-inferior corner of C6 (arrow). Sagittal T2-weighted MRI (B) displays cord injury (

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