The debate over whether a patient has atrophy or hydrocephalus has consumed an enormous number of pages in the neuroradiologic literature and whole sessions of national meetings. Why the fuss? Well, the implications as far as prognosis and treatment are vastly different between the two, so accurate distinction is essential! Atrophy reflects the loss of brain tissue, be it cortical, subcortical, or deep. With the loss…

White matter diseases are heterogeneous conditions linked together because they involve the same substrate. Magnetic resonance imaging (MRI) is quite sensitive and, when combined with age and other pertinent clinical information, provides a reasonable amount of specificity for white matter lesions. We are going to start by dividing white matter diseases into demyelinating ( Box 6-1 ) and dysmyelinating diseases ( Box 6-2 ). BOX 6-1…

A plethora of infectious and noninfectious inflammatory diseases affects the central nervous system (CNS). The normal brain responds to these insults in a rather limited, unimaginative, and stereotypical masculine manner. Initially it gets rubor (increased perfusion), calor (hot), tumor (edematous) but without dolor (pain) unless the meninges (surface) are affected. In most cases, there is a concomitant abnormality of the blood-brain barrier with associated enhancement. Later,…

Let’s start off with some depressing statistics. Traumatic brain injury (TBI) has an incidence of over 500,000 cases per year, and is the leading cause of disability and death in children and young adults in the United States. The annual cost of TBI, including direct costs and lost income, is estimated to be above $25 billion. It has a peak incidence in 15- to 24-year-olds with…

Imaging is an essential component in the workup of patients presenting with symptoms of stroke. “Stroke” is a nonspecific clinical term denoting a sudden loss of neurologic function by any cause (e.g., ischemic infarction, spontaneous hemorrhage, post ictal state). A host of new and evolving imaging techniques have been developed in the recent past allowing for ever more accurate and timely detection and characterization of stroke…

The World Health Organization (WHO) classification of tumors of the brain remains the worldwide standard. Members of the International Society of Neuropathology, International Academy of Pathology, and Preuss Foundation for Brain Tumor Research met in Lyon France for several bottles of wine and a lengthy discussion of whether to use “tumor” or “tumour” among other topics. Late at night, over brie and baguettes they subsequently produced…

The anatomy and function of the brain is fascinating and complex, and we are still only scratching the surface in terms of our understanding of these structures. Nevertheless, a basic understanding of structure and function is critical in providing meaningful and accurate reporting of the pathology in the brain. Although we will discuss the development of the brain in Chapter 8 , we will address the…