Neuroscience Clerkship

 

 

NEURORADIOLOGY TEACHING FILE


The Neuroradiology Teaching File below is composed of (3) separate sections.

The first section is NORMAL IMAGING ANATOMY, including MRI of the Brain, MRI of the Spine, MRA, MRV, CT and Angiography. For the MRI and CT slices, the pages are interactive - after placing the cursor over a structure, the anatomic name of the structure will appear. In addition, in this section are (5) powerpoint presentations available for download that allow you to systematically learn normal MRI, CT and MRA anatomy.

The second section contains examples of COMMON AND CLASSIC PATHOLOGIC CONDITIONS. In addition to the image, each has some clinical information on how the patient presented and an explanation of the findings on imaging. These are the conditions that students should be familiar with.

The last section is UNCOMMON AND UNUSUAL PATHOLOGIC CONDITIONS. Most are very rare. Review of this information is not required for medical students.


Normal Imaging Anatomy

     •  Magnetic Resonance Imaging (MRI)

Brain - Interactive Anatomy

Sagittal T1-weighted

 

 

 

 

 

 

 Mid-sagittal


Axial T2-weighted

Cord
Medulla
Pons
Midbrain
Basal Ganglia
Lateral Ventricles
Centrum Semiovale
Vertex

Coronal T1-Weighted

•   Orbits and Frontal Pole
•  Genu - Corpus Callosum
Anterior Horns - Lateral Ventricles
Optic Chiasm
Basal Ganglia
Thalamus
Posterior Third Ventricle
Pineal Gland
Splenium - Corpus Callosum
Posterior Horns - Lateral Ventricles
Carcarine Sulcus

Coronal MP-RAGE

Frontal Pole
Frontal Pole / Orbit
Posterior Orbit
Genu of the Corpus Callosum
Anterior Head of the Caudate Nucleus
Caudate and Putamen
Optic Chiasm
Anterior Commissure
Third Ventricle
Mamillary Bodies

MP-RAGE (Magnetization Prepared RApid Gradient Echo) is a rapid gradient-echo technique used to enhance contrast. These are very similar to the T1-weighted images above, but have a higher signal intensity and image contrast that allows for better visualization of anatomy.

Thalamus
Precentral and Postcentral Gyri
Cerebral Aqueduct
Fourth Ventricle
Splenium of the Corpus Callosum
Posterior Horns of the Lateral Ventricles
Parietal / Occipital Lobes
Occipital Lobes
Occipital Pole

  •  Magnetic Resonance Imaging (MRI)
    Cervical Spine (interactive anatomy)
      Sagittal
      Axial
    Lumbar Spine
      Sagittal
      Axial
        Axial T1 and T2
        Interactive anatomy  

  •  Magnetic Resonance Angiography (MRA)
    Extracranial (arch study)
    Extracranial (neck study)
    Intracranial (circle of Willis)
      AP Projection
      Caudal/Rostral Projection

  •  Magnetic Resonance Venography (MRV)
    Lateral View
    Oblique View
    AP View
  Diagram of the Dural Venous Sinuses

  •  Computerized Tomography (CT)
    Brain - Interactive Anatomy
      Axial
        •  Cord
        •  Medulla
        •  Pons
        •  Lower Midbrain
        •  Upper Midbrain
        •  Lower Basal Ganglia
        •  Upper Basal Ganglia
        •  Lateral Ventricles
        •  Centrum Semiovale
        •  Vertex

  •  Conventional Angiography
    Common Carotid
    Internal Carotid
    Vertebral Basilar

Normal Imaging Anatomy - Slide Shows
     •  CT - Brain - Axial


    
  MRI - Brain - Axial

    
  MRI - Brain - Sagittal

    
  MRI - Brain - Coronal

    
  MRA - Extracranial (neck and arch) and Intracranial

 


Common and Classic Pathologic Conditions

Degenerative

  Cerebellar Degeneration
  Corticobasal ganglionic degeneration (CBGD)
  Dementia
    Alzheimer's
    Frontotemporal Dementia
    Creutzfeldt–Jakob disease (review)
  Huntington's
  Spinocerebellar Ataxia
    SCA
    SCA - Type 2
          return to top

Demyelination

  Acute Disseminated Encephalomyelitis (ADEM)
    Case 1
    Case 2
      MRI Brain
      MRI Spinal Cord
  Multiple Sclerosis
    Initial Presentation
      Case 1
      Case 2
    Advances Cases
      Case 1
      Case 2
      Case 3
        Flair MRI
        Gadolinium-enhanced
      Case 4 - Tumefactive
      Case 5
  Transverse Myelitis
    Case 1
    Case 2
    Case 3
  Toxic Leukoencephalopathy from Heroin
          return to top

Developmental and Congenital

  Agenesis of the Corpus Callosum
  Arachnoid Cyst
    Middle Cranial Fossa
      Case 1
      Case 2
      Case 3
    Posterior Cranial Fossa
      Case 1
      Case 2
  Arteriovenous Malformation
    Case 1
      CT Scan
      Angiogram
    Case 2
    Case 3
      CT Scan
      MRI Scan
      Angiogram
    Case 4
      MRI Scan
      Angiogram
    Case 5
      MRI Axial Scans
      MRI Coronal Scans
      MRI Sagittal Scans
      MRA
      Angiogram
    Case 6
      MRI Axial Scans
      Angiogram
  Cavernous Angioma
  Cavum Vargae
  Chiari 1 Malformation
    Case 1
    Case 2
    Case 3
  Chiari 2 Malformation
    Axial Scans
    Sagittal Scans
  Colloid Cyst of the Third Ventricle
    Case 1
    Case 2
  Dandy Walker
  Heterotrophia
  Spinal Arteriovenous Malformation
    Case 1
      MRI Scans
      Angiogram
    Case 2
  Tuberous Sclerosis
    Case 1
    Case 2
  Venous Malformation
    Case 1
      T1 and T2 MRI
      T1 MRI with Gadolinium
      Angiogram
    Case 2
    Case 3
          return to top

Herniation

  Transtentorial Herniation (from a Glioma)
  Subfalcine Herniation (from a MCA stroke)
  Midline Shift and Herniation (from a massive MCA/PCA stroke)
  Midline Shift and Herniation (from a Subdural Hematoma)
          return to top

Hydrocephalus

  Communicating
    Case 1
      CT Scan
      MRI Scan
    Case 2
    Case 3
  Non-communicating
    Compensated
    Uncompensated
      Acute Bleed into a Cerebellar Tumor
      Acute Shunt Malfunction
      Acute Cerebellar Stroke
      Aqueductal Stenosis
        Case 1
        Case 2
      Colloid Cyst
      Prematurity / Prior Intraventicular Hemorrhage
      Subarachnoid Hemorrhage (SAH)
            return to top

Infection / Granulomatous

  Brain Abscess
    Case 1
    Case 2
      CT Scan
      MRI Scan
    Case 3
      CT and MRI Scans
      MRI Scans
  Creutzfeldt–Jakob disease (review)
  Epidural Spinal Abscess
  Herpes Encephalitis
    Case 1
    Case 2
    Case 3
  Lumbar Discitis and Osteomyelitis
    Sagittal View
    Axial View
  Progressive Multifocal Leukoencephalopathy (PML)
    Affecting Cerebral White Matter
      Case 1
      Case 2
    Affecting Brainstem White Matter
  Sarcoidosis
  Sinusitis and Epidural Abscess
    MRI - T1 with gadolinum
  Subdural Empyema
    MRI - T2
    MRI - T1 with gadolinium
  Toxoplasmosis
    CT Scan
    MRI Scan
  Tuberculoma
    MRI Axial
    MRI Coronal
              return to top

Peripheral Nerve

  Guillain-Bar Syndrome
  Lumbar Plexopathy - Lymphoma
  Retroperitoneal Hemorrhage / Lumbar Plexopathy
    Case 1
    Case 2
      CT
      MRI Coronal
            return to top

Spinal

  Anterior Spinal Artery Stroke
  B12 Deficiency
  Cervical Spinal Stenosis
    Case 1
    Case 2
  Compression Fracture - L2
  Epidural Abscess
  Epidural Hematoma
  Herniated Disk
    Cervical C3 - C4
    Thoracic 9
    Lumbar 3 - 4
    Lumbar 5 - Sacral 1
      Case 1
      Case 2
  Lumbar Discitis and Osteomyelitis
    Sagittal View
    Axial View
  Lumbar Stenosis
    Spondylosis
      Mild-Moderate
      Moderate
      Severe
    Spondylolithesis
      Sagittal
      Axial
  Neoplastic
    Cauda Equina Compression
    Infiltration of the Cauda Equina
      Carcinomatous Infiltration
      Leukemic Infiltration
      Neurolymphomatosis
        Case 1
        Case 2
          Axial MRI at L4 Level
          Axial MRI at L1 Level
          Sagittal MRI
    Intramedullary Tumor
      Ependyoma
    Metastasis to Pedicle
      Sagittal MRI
      Axial MRI
    Schwannoma
      C1
      C7
      L3
    Spinal Cord Compression
      Endometrial Carcinoma
      Lung Carcinoma
      Melanoma
      Renal Cell Carcinoma
        Sagittal MRI
        Axial MRI
  Syrinx
    Case 1
      Sagittal View
      Axial View
    Case 2
    Case 3
    Case 4
  Tarlov Cyst
    Axial Scan
    Sagittal Scan
  Tethered Cord
    Case 1
    Case 2
      Sagittal Scans
      Comparison to a Normal Spine
  Transverse Myelitis
    Case 1
    Case 2
    Case 3
            return to top

Stroke - Ischemic

  Middle Cerebral Artery
    Superior Division
      Case 1 - CT Scan
      Case 2 - MRI Scan
      Case 3 - Remote - MRI Scan
    Inferior Division
      Case 1 - MRI
      Case 2 - CT
    Distal Stem
      Case 1 - MRI
      Case 2 - CT
    Proximal Stem
      Proximal Stem
      Proximal Stem with Persistent Fetal Circulation
     MCA Infarction with Secondary Hemorrhagic Transformation
      Case 1
      Case 2
    MCA Branch
      Case 1 - MRI
      Case 2 - CT
    Multiple MCA Branches
    Combined Middle and Posterior Cerebral Infarction
      Case 1
      Case 2 (requiring hemicraniectomy)
      Case 3
    Bilateral MCA
      Diffusion-weighted MRI
      CT scan
      Angiogram
    MCA - ACA
  Anterior Cerebral Artery
    Case 1
    Case 2
    Case 3
    Case 4
  Posterior Cerebral Artery
    Case 1
    Case 2
    Case 3
    Case 4 - Proximal Infarction
    Case 5 - Proximal Infarction
  Posterior and Middle Cerebral Artery - Stroke Evolution
  Watershed Infarction
    Middle/Anterior Cerebral
      Case 1
      Case 2
      Case 3
    Middle / Posterior Watershed
    Anterior / Middle / Posterior
      Case 1
      Case 2
    Deep Basal Ganglia and Capsule
  Lacunar Infarction
    Internal Capsule
      Case 1
      Case 2
      Case 3
    Pons
    Thalamus
    Multiple Lacunar State
      Case 1
      Case 2
      Case 3 (Cadasil)
  Brainstem Infarction
    Medial Medulla
    Lateral Medulla / Inferior Cerebellum (PICA)
      Lateral Medulla (isolation)
      Inferior Cerebellum (isolation)
        Case 1
        Case 2
        Case 3
    Lateral Medulla and Inferior Cerebellum
      Case 1
        MRI - Flair and Diffusion Images
        Dissection Protocol and MRA Images
      Case 2
        MRI - Flair
        Diffusion Image
    Pons
      Case 1
      Case 2
      Case 3
    Midbrain
    Midbrain and Pons (Basilar artery)
    Multiple Brainstem and Cerebellar Strokes
      Case 1
        MRI T2 axial
        MRI Diffusion-weighted
        CT Scan
      Case 2
      Case 3
    Cerebellar and Posterior Cerebral Artery Strokes
  Atherosclerosis - Large Vessel
    Internal Carotid Artery
      Stenosis
        Case 1
        Case 2
        Case 3
        Case 4
        Case 5
        Case 6
      Occlusion
        Case 1
        Case 2
        Case 3
    Vertebral Artery
      Intracranial
        Case 1
        Case 2
        Case 3
      Extracranial
        Case 1
        Case 2
        Case 3
    Basilar Artery
      Mild-Moderate Stenosis
        Lateral View
        AP View
      Severe
        Case 1
        Case 2 (before and after angioplasty)
    Intracranial Disease
      Case 1
      Case 2
      Case 3 (Moyamoya Disease)
  Dissection
    Carotid Artery
      Case 1
        MRA
        Fat Suppression MRI
      Case 2
      Case 3
      Case 4
      Case 5
      Case 6
      Case 7
      Case 8
        Fat Suppression MRI
        Angiogram
    Vertebral Artery
      Case 1
        MRA
        Fat Suppression MRI
      Case 2
        MRI - T2 and Diffusion
        MRA
        MRA Source Images
        Fat Suppression MRI
      Case 3
  Cardiac Emboli
    Case 1 - Shower of Emboli
    Case 2- Shower of Emboli
    Case 3 - MCA Embolus
    Case 4 - Aortic Thrombus
  Thrombolysis (TPA)
    Case 1 - Basilar Occlusion
      Diffusion-weighted MRI
      Angiogram: Pre-TPA
      Angiogram: Post-TPA
  Cerebral Vasculitis
    Case 1
    Case 2
      Angiogram (ICAs AP view)
      Angiogram ( ICAs Lateral view)
      Angiogram (Left ICA with detailed view)
    Case 3 (HIV)
      MRI Brain
      Cerebral Angiogram
  Hypertensive Encephalopathy (Reversible Posterior Leukoencephalopathy)
    Case 1
    Case 2
    Case 3
  Anoxia
    Case 1
    Case 2
      MRI - Diffusion
      MRI - Flair
      CT Scan
    Case 3  
              return to top

Stroke - Intracerebral Hemorrhage

  Blood on MRI: Time-dependent Changes  (Slide Show)
  Hyperacute
    Case 1
    Case 2
  Acute
    Case 1
    Case 2
    Case 3
    Case 4
    Case 5
    Case 6
  Subacute Early
    Case 1
    Case 2
    Case 3
  Subacute Late
  Chronic
    Case 1
    Case 2
    Case 3
    Case 4
  Hypertensive
    Basal Ganglia
      Putamen (large)
        Case 1
        Case 2
        Case 3
      Putamen (small)
      Extension to Temporal Lobe
      Caudate
    Basal Ganglia and Thalamus
    Thalamus
      Intraparenchymal
        Case 1
        Case 2
        Case 3
      Extension into the Ventricles
        Case 1
        Case 2
        Case 3
      CT vs MRI Comparison
    Pons
      Case 1 - CT scan
      Case 2 - MRI scan
      Case 3 - Lateral Pons
    Cerebellum
      Case 1
      Case 2
      Case 3
      Case 4
      Case 5
    Lobar
      Case 1 - Frontal
      Case 2 - Frontal
      Case 3 - Temporal
      Case 4 - Frontal
      Case 5 - Temporal
  Intracerebral Hemorrhage from Anticoagulation
  Amyloid Angiopathy
    Case 1 - MRI
    Case 2 - CT
  Hemorrhagic transformation of an Ischemic Infarct
    Case 1
    Case 2
  Microbleeds
            return to top

Stroke - Subarachnoid Hemorrhage

  CT Imaging
    Case 1
    Case 2
    Case 3
    Case 4
    Case 5 - Sentinel Bleed
    Case 6 - Sentinel Bleed
    Case 7
  Anterior Communicating Artery Aneurysm
    Case 1
    Case 2
    Case 3
    Case 4
    Case 5
    Case 6
      CT Scan
      Angiogram
  Anterior Communicating Artery Aneurysm and Fibromuscular Dysplasia
  Anterior Cerebral Artery
  Ophthalmic Artery / ICA Aneurysm
    Case 1
    Case 2
  Posterior Communicating Artery Aneurysm
    Case 1
    Case 2
    Case 3
  Middle Cerebral Artery Bifurcation
    Case 1
    Case 2
    Case 3 - Giant Aneurysm
      CT
      MRI
      MRA
      Angiogram
    Case 4
  Basilar Artery Aneurysm
    Case 1
      CT Scan
      Angiogram
      Angiogram post-coiling
    Case 2
    Case 3
      CT
      MRI
      Angiogram
    Case 4
      CT
      Angiogram
  Top of the Carotid Aneurysm
  Internal Carotid Artery - Giant Aneurysm
  Vertebral - PICA Aneurysm
  Superior Cerebellar Artery (SCA) Aneurysm
  Delayed Complications of Subarachnoid Hemorrhage
    Hydrocephalus
      Case 1
      Case 2  
    Vasospasm
      Case 1
      Case 2
      Case 3
      Case 4
      Case 5
        Angiogram - AP view
        Angiogram - Lateral view
      Case 6
  Intraventricular Hemorrhage
              return to top

Stroke - Venous

  Cerebral Sinus Thrombosis
    Case 1
      CT Scan
      MRI
        T2
        Gradient Echo
      Angiogram
        Left ICA Injection
        Right ICA Injection
    Case 2
      CT Scan
      MRV
    Case3 - Deep Cerebral Venous Thrombosis (review)
      MRI
      MRV
      Angiogram
    Case 4 - Transverse and Sigmoid Sinus Thrombosis
    Case 5 - Transverse and Sigmoid Sinus Thrombosis
    Case 6 - Transverse and Sigmoid Sinus
      MRI T1, T2 and Flair - Temporal /  Parietal Area
      MRI T1 and T2 - Sigmoid Sinus
      MRI T1 with gadolinium
      MRV
            return to top

Trauma

  Cerebral Contusion
    Frontal Pole Contusions
      Case 1
      Case 2
      Case 3
    Temporal Tip Contusion
    Multiple Contusions
  Epidural Hematoma
  Multiple Hemorrhage Types
    Case 1
    Case 2
  Subdural Hematoma
    Unilateral
      Acute
        Case 1
        Case 2
        Case 3
        Case 4
      Subacute (isodense)
        Case 1
        Case 2
        Case 3
      Chronic
        Case 1
      Acute on Chronic
        Case 1
        Case 2
        Case 3
        Case 4
    Bilateral
      Acute
        Case 1
        Case 2
        Case 3
      Chronic
        Case 1
              return to top

Tumor

  Glioblastoma Multiforme (GBM)
    Frontal
      Case 1
      Case 2
      Case 3
        T2, T1 with gadolinium, GE images
        Coronal and Sagittal images
      Case 4
      Case 5
        Axial images
        Coronal and Sagittal images
      Case 6
      Case 7
      Case 8
    Parietal
      Case 1
      Case 2
        Flair MRI
        T1 with gadolinium
    Temporal
    Thalamic
      Case 1
      Case 2
    Occipital
  Lower Grade Glial Tumors
    Case 1
    Case 2
      Axial
      Coronal and Sagittal
    Case 3
    Case 4
      Axial
      Coronal and Sagittal
    Case 5 - Optic Nerve Glioma
    Case 6 - Oligodendroglioma
    Case 7 - Astrocytoma - Corpus Callosum
    Case 8 - Mixed Oligodendroglioma / Astrocytoma
    Case 9 - Pilocystic Astrocytoma
      Axial T1 and T2 MRI
      Flair and Sagittal T1 MRI
    Case 10 - Pilocystic Astrocytoma
  Meningioma
    Solitary
       Frontal
        Case 1
        Case 2
        Case 3
       Frontal - Parafalcine
        Case 1
          T2 Axial
          T1 Axial and Coronal with Gadolinium
        Case 2
          Axial MRI
          Coronal and Sagittal MRI
        Case 3
          CT Scan
          Coronal MRI
        Case 4
        Case 5
      Frontal Operculum
      Temporal Pole
      Temporal
      Frontal-Parietal
        Axial
        Coronal and Sagittal
      Parietal
        Case 1
        Case 2
      Cavernous Sinus
      Sphenoid Wing
        Axial Views
        Sagittal and Coronal Views
      Tentorial
      Mid-sagittal with Invasion of the Sagittal Sinus
        Axial
        MRV
      Clivus
        Axial (Foramen Magnum)
        Axial (Medulla)
        Coronal and Sagittal
    Multiple
  Medulloblastoma
    Axial  Scans
    Flair Axial, Coronal and Sagittal Scans
  Ependyoma
    MRI T2
    MRI T1 with gadolinium
  Pituitary
    Microadenoma
      Case 1
      Case 2
    Macroadenoma
      Case 1
      Case 2
      Case 3
        Sagittal MRI
        Coronal MRI
      Case 4
      Case 5
      Case 6
    Apoplexy
      Case 1
      Case 2
  Craniopharynioma
  Schwannoma
    Trigeminal Nerve
    Cervical Nerve Root and Spinal Cord Compression
    Cerebellar-Pontine Angle
    Acoustic Neuroma (CN VIII)
      Case 1
      Case 2
  Pinealoma
    Axial T1 and T2
    Axial Flair and Coronal T1
    Sagittal T1 and T1 with Gadolinium
    Associated Hydrocephalus
  CNS Lymphoma
    Axial Scans
    Coronal Scans
  Metastatic Disease
    Breast Cancer
      Case 1
      Case 2
      Case 3
      Case 4
    Lung Cancer
      Case 1
      Case 2
      Case 3
        Axial MRI
        Coronal and Sagittal MRI
        Chest CT
      Case 4
      Case 5
      Case 6
    Lymphoma
    Melanoma
      Case 1
      Case 2
            return to top

Miscellaneous

  Calcification of the Basal Ganglia and Cerebellum
  Herniation of Brain through Craniectomy Sites
  Missing Brain s/p Craniectomy
  Pneumocephalus
    Case 1
      Head CT
      Head CT (Bone windows)
    Case 2
  Wernicke's Encephalopathy
    Case 1
    Case 2
            return to top

Uncommon and Unusual Pathologic Conditions

Degenerative
 

Demyelination

Developmental and Congenital

Hydrocephalus
 
Infection Spinal
Stroke - Ischemic
 
Stroke - Hemorrhagic Stroke - Venous

Trauma

Tumor Miscellaneous

Degenerative

  Primary Lateral Sclerosis

Demyelination

  Leukodystrophy
  Alexander's Disease

Developmental and Congenital

  Agenesis of the Corpus Callsoum
  Chairi Malformation - Type I
    Case 1
  Chiari Malformation - Type II
  Aqueductal Stenosis
  Cortical Dysplasia
  DiGeorge Syndrome
  Hydranencephaly
  Zellwenger
  Achrondoplasia
  Acardi Syndrome
    Axial Flair
    Axial T2
  Brachyturrencephaly
  Hypothalamic Hamartoma
  Porencephaly
  Shizencephaly
    Closed Lip
    Open Lip
  Trigonencephaly

Hydrocephalus


Infection

  Brain Abscess from a Pulmonary AV Fistula
  CNS Whipple's

Spinal

  Epidural Lipomatosis
  Spinal Infarct

Stroke - Ischemic

  Cadasil
    Case 1
  MELAS
  Mediport Embolism
    MRI
    Mediport-o-gram
  Susac's Syndrome
    MRI Axial
    MRI Sagittal

Stroke - Hemorrhagic

   

Stroke - Venous


Trauma

  Vertebral Artery Pseudoaneursym after Stabbing

Tumor

  Pilocystic Cerebellar Astrocytoma
  Primitive Neuroectodermal Tumor (PNET)
  Central Neurocytoma

Miscellaneous