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Introduction to Neuro Radiology

Condition  Recommended Technique
 Acute  CT
 Subacute/chronic  MRI
 Subarachnoid hemorrhage(Acute)  CT, CTA, lumbar puncture angiography
Subarachnoid hemorrhage(Chronic) MRI
 Aneurysm  Angiography > CTA, MRA
 Ischemic infarction  
 Hemorrhagic infarction  CT or MRI
 Ischemic infarction  MRI > CT, CTA, angiography
 Carotid or vertebral dissection  MRI/MRA
 Vertebral basilar insufficiency  CTA, MRI/MRA
 Carotid stenosis  MRA> CTA > Doppler ultrasound
 Suspected mass lesion  
 Neoplasm, primary or metastatic  MRI + contrast
 Infection/abscess  MRI + contrast
 Immunosuppressed with focal findings  MRI + contrast
 Vascular malformation  MRI +/- angiography
 White matter disorders  MRI
 Demyelinating disease  MRI +/- contrast
 Dementia  MRI > CT
 Acute trauma  CT (noncontrast)
 Shear injury/chronic hemorrhage  MRI
 Headache/migraine  CT (noncontrast) / MRI
 First time, no focal neurologic deficits  CT as screen +/- contrast
 Partial complex/refractory  MRI with coronal T2W imaging
 Cranial neuropathy  MRI with contrast
 Meningeal disease  MRI with contrast
Neurosonography Q
  • Advantage of USG over CT/MR for neurological imaging in infants:
  • Portable
  • Cheap
  • Multiplanar dynamic scanning
  • Easy to perform
  • Lack of ionizing radiations    
  • No need for sedation
  • Especially best for screening for ICH, hydrocephalus and PVL.Q
  • Anterior FONTANELLE(till 12 TO 14 MONTHS) most vital window
  • Foramen magnum (for posterior fossa evaluation)
  • Squamous part of temporal bone
  • The neurosonogram (5-7.5 Mhz sector probe is preferable) is possible because of the acoustic windows available in infants:
Computed tomography
Head CT is often normal in acute stroke. 
The earliest sign (within 6 hours) of an acute infarct on CT is loss of the gray-white differentiation with obscuration of the lateral lentiform nucleus. 
Acute ischemic changes can be seen within minutes of onset of the ictus on diffusion-weighted MRI. 
Hypodense brain lesions on CT
  1. Infarct                
  2. Non-hemorrhagic contusion        
  3. Brain tumors
  4. Brain edema            
  5. Metabolic encephalopathy        
  6. Hypertensive encephalopathy
  7. Pseudotumor cerebri        
  8. Encephalitis
Q Hyperdense brain lesions
  1. Intracranial calcification                
  2. Infection (TORCH)        
  3. Neoplasms
  4. Endocrinal (Hypoparathyroidism)            
  5. Embryologic (Neurocutaneous syndromes)
  6. Arteriovenous lesions (aneurysms, AVM, hemangioma, SDH, SAH, EDH, ICH)
  7. Lipoma                    
  8. Lipoid proteineosis        
  9. Lissencephaly
  1. Physiological intracranial calcification
    1. Pineal gland (60% of adults, seen approximately 30 mm above highest posterior elevation of pyramids and pineal calcification more than 14 mm suggests pineal neoplasm)
    2. Habenular commissure (30%) and seen 4–6 mm anterior to pineal glands as posteriorly openC-shaped calcification
    3. Choroid plexus (10% most commonly in glomus within atrium of lateral ventricles)
    4. Arteriosclerosis (carotids, basilar and vertebral arteries)
    5. Basal ganglia
    6. Pituitary gland (rare)
    7. Dura mater
      1. Falx cerebri (7%) and superior sagittal sinus                          
      2. Tentorium
      3. Dural plaques (frequently parasagittal)                                    
      4. Petroclinoid (12%) and interclinoid ligaments
      5. Diaphragm sellae
  2. Basal ganglia calcification
    1. Physiological/idiopathic (primary) (typically bilateral and symmetric and commences in the region of head of caudate nucleus)
    2. Secondary to:
      1. Hypoparathyroidism Q
      2. Pseudohypoparathyroidism (Albright's syndrome) Q
      3. hyperparathyrodism
      4. Familial
      5. Fahr's syndrome (Familial ferocalcinosis) Q
      6. Cockayne’s syndrome
      7. Lead and CO poisoning Q
      8. Methotrexate with Radiation therapy (mineralizing microangiopathy of leukemia)
      9. Birth asphyxia Q
  3. Pathological Calcification in brain elsewhere
    1. periventricular calcification: CMV infection
    2. diffuse nodular calcification: toxoplasmosis
    3. rice grain calcification: neurocysticercosis

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