Brain imaging course – Unknown case 5

Описание: This video is the 5th unknown case that goes with the brain imaging capstone course.

If you want to follow along, you can find all the images for the case at the brain capstone website:
https://learnneuroradiology.com/brain...

0:00 Introduction

51 year-old-female presents with left sided weakness and numbness

0:33 Interactive review - CT

This case features a CT with a brain window on the left and a bone window on the right. As you scroll up, you start to note that the right lateral ventricle is a little compressed and there is loss of the normal sulci on the right. If you window it really tightly, you can start to see the outlines of a mass along the parietal convexity. In this case, we want to get an MRI so we can better evaluate it.

1:54 Interactive review - MRI

The MRI includes diffusion weighted imaging, FLAIR, T2, and pre- and post-contrast T1 weighted imaging. On diffusion, the mass is faintly hyperintense but pretty homogeneous with compression of the brain away from the mass. Similarly, on FLAIR, the mass is pretty homogeneous and has a large contact with the dura and adjacent calvarium. The T2 is particularly helpful because you see a thin cleft of CSF around the mass (a CSF cleft). You also see a little bit of a radial spoke type pattern radiating out from the calvarium where the bone is abnormal. On pre-contrast T1, the mass is pretty isointense to slightly hypointense to the adjacent gray matter. On postcontrast, you see homogeneous and avid enhancement and again are able to make out the CSF cleft. The coronal postcontrast images confirm the findings you saw on axial imaging

5:14 Interactive question 5

Is this lesion intra-axial or extra-axial? It is extra-axial
How do you know? You have a thin CSF cleft, compression of the brain away from the mass, and a thin dural tail.

6:01 CT explanation

Some select images from the CT are shown here, where you can see the subtle mass and bony erosion. There are some examples from a CT angiogram showing displacement of the dural vessels away from the mass. An additional representative example shows vessels radiating out from the central portion of the mass.

6:01 MRI explanation

Select images from the MRI show key images highlighting the CSF cleft sign, the dural tails, and the avidly enhancing extra-axial mass.

7:23 Diagnosis - Meningioma

This is a case of a meningioma. These usually occur in older patients more than 40 years old and present with symptoms of brain compression or increased intracranial pressure. Meningiomas range from grade 1-3. The treatment of meningioma is usually surgical resection, sometimes with radiation afterwards. If they are in delicate locations or the patient has health problems making surgery less desirable, you can treat them with radiation alone.

Thanks for tuning in to this case. There are a total of 7 cases you can review on your own at the website and explanations will be posted here. Be sure to check back in for additional videos in the future or check out the website at
https://www.learnneuroradiology.com