Learning from the mistakes

Case of the month, January 2020

This is 27 weeks GA of fetus. During second level ultrasound examination, perinatologist referred this baby with bilateral ventriculomegaly and non-visualization of CSP. For further evaluation we acquired brain MRI. What is your diagnosis?

  • On axial images, there is no fluid-filled septum pellicidum.
  • At the level ventricles, there is a dysmorphic appearance of posterior horns of the lateral ventricles.
  • Hemispheres are separated by falx and interhemispheric fissures at the anterior and posterior parts. But there is continuity in the middle section.
  • On sagittal images, it is evident that corpus callosum genu and splenium are present, but the body of the CC is absent.
  • Syntelencephaly, also known as middle interhemispheric variant (MIHV), is a mild subtype of holoprosencephaly that is characterized by an abnormal midline connection of the cerebral hemispheres between the posterior frontal and parietal regions.
  • In middle interhemispheric variant (MIH) there is failure of separation of the posterior frontal and parietal lobes whereas the poles of the frontal and occipital lobes are well separated. The genu and splenium of the corpus callosum appear normally formed, but the callosal body is absent. The hypothalamus and lentiform nuclei appear normally separated, but the caudate nuclei and thalami are incompletely separated in many cases. The sylvian fissures in most patients orient nearly vertically and connect abnormally across the midline over the vertex of the brain. Approximately two thirds of the MIH patients have either subcortical heterotopic gray matter or cortical dysplasia.

Case of the month, February 2020

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This is 27 weeks GA of fetus. During second level ultrasound examination, perinatologist referred this baby with bilateral ventriculomegaly and non-visualization of CSP. For further evaluation we acquired brain MRI. What is your diagnosis?

Case of the month, March 2020

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This is 27 weeks GA of fetus. During second level ultrasound examination, perinatologist referred this baby with bilateral ventriculomegaly and non-visualization of CSP. For further evaluation we acquired brain MRI. What is your diagnosis?

Case of the month, April 2020

20-years-old female residing in a rural area presented to the hospital with fever, headache, inability to walk and urinary retention . Clinical examination revealed rashes on her hands.

  • MRI of the spinal cord shows LETM in the spinal cord. There is nearly full-thickness involvement of the spinal cord in cross section.
  • Sagittal T1 post-contrast image shows leptomeningeal and cord enhancement. Enhancement of spinal nerve roots has is also observed in the lower spinal cord and cauda equina.
  • At the level of spinal nerve roots, there is both thickening of the nerve roots and pathological enhancement.
  • Multiple cranial nerve enhancement involving the right facial nerve and left trigeminal nerves in particular.
LYME DISEASE:
  • Cord involvement is actually rare. 
  • Myelopathy diffuse or multifocal.
  • In the setting of acute transverse myelitis, additional findings of nerve root or leptomeningeal enhancement can be helpful imaging features in differentiating Lyme from MS and other causes of centrally located myelitis such as acute disseminated encephalomyelitis and NMOSD.
  • Findings of LETM, cranial nerve involvement, leptomeningeal enhancement of spinal cord and spinal nerve roots, facial paralysis, and a rash on the skin should prompt exclusion of Lyme disease (neuroborreliosis).

Case of the month, May 2020

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This is 27 weeks GA of fetus. During second level ultrasound examination, perinatologist referred this baby with bilateral ventriculomegaly and non-visualization of CSP. For further evaluation we acquired brain MRI. What is your diagnosis?

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