Imaging in Neurology

Intracranial Atherosclerosis

KEY FACTS Terminology Intracranial atherosclerotic vascular disease (ASVD) Intracranial atherosclerotic stenosis (ICAS) Imaging Gold standard is now high-resolution MR (HRMR) with direct vessel wall imaging HRMR vessel wall imaging > > depicting lumen (DSA, CTA, MRA) Imaging findings (HRMR) Crescent-shaped…

Arteriolosclerosis

KEY FACTS Terminology Sclerosis of small-sized arteries (arterioles) Common with chronic hypertension (HTN) &/or diabetes May lead to vascular dementia (VaD) Imaging Multifocal white matter (WM) hypodensity on CT Patchy/confluent ↑ T2/FLAIR hyperintensities Broad or confluent base with ventricles Periventricular…

Hypertensive Intracranial Hemorrhage

KEY FACTS Terminology Hypertensive intracranial hemorrhage (hICH) Acute nontraumatic intracerebral hemorrhage (ICH) secondary to systemic hypertension 2nd most common cause of stroke Imaging Initial screen = NECT in patients with HTN CT: Acute round or oval hyperdense mass Striatocapsular: Putamen/external…

Spontaneous Nontraumatic Intracranial Hemorrhage

KEY FACTS Terminology Primary intraparenchymal hemorrhage (pICH) Acute nontraumatic intracranial hemorrhage (ICH) Imaging Acute round or oval intracerebral hematoma Subcentimeter “microbleeds” to massive ICH Hematoma location for common causes of pICH HTN: Basal ganglia > thalamus > pons > cerebellum…

Evolution of Intracranial Hemorrhage

KEY FACTS Imaging CT: Hemorrhage appearance based on density Hyperdense mass (50-70 Hounsfield units) on NECT Peripheral edema develops over 1st few days MR: Intracranial hemorrhage staging based on T1 and T2 signal characteristics MR as sensitive as CT in…

Stroke Overview

Introduction Stroke is a generic term that describes the clinical event of a sudden onset of neurologic deficit secondary to cerebrovascular disease. Stroke has 4 main etiologies, including cerebral infarction (80%), intraparenchymal hemorrhage (15%), nontraumatic subarachnoid hemorrhage (5%), and venous…

Intracranial Venous System Overview

TERMINOLOGY Abbreviations Superior sagittal sinus (SSS) Inferior sagittal sinus (ISS) Internal cerebral vein (ICV) Straight sinus (SS) Great cerebral vein (vein of Galen, VofG) Transverse sinus (TS) Superior/inferior petrosal sinuses (SPS/IPS) Cavernous sinus (CS) Internal jugular vein (IJV) Basal vein…

Intracranial Arteries Overview

TERMINOLOGY Abbreviations Anterior, middle, posterior cerebral arteries (ACA, MCA, PCA) Anterior, posterior communicating arteries (ACoA, PCoA) Basilar artery (BA) Vertebral artery (VA) Anterior, posterior inferior cerebellar arteries (AICA, PICA) Anterior choroidal artery (AChoA) Recurrent artery of Heubner (RAH) GROSS ANATOMY…

Chronic Traumatic Encephalopathy

KEY FACTS Terminology Definition Neurodegenerative disease secondary to repetitive concussive/subconcussive head injuries Synonyms Dementia pugilistica (“punch-drunk”) Postconcussion syndrome Imaging MR Age-inappropriate volume loss – Voxel-based morphometry shows disproportionate involvement of medial temporal lobes Nonspecific T2/FLAIR punctate, confluent hyperintensities in deep,…