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Vertebral Compression Fractures

CASE A An 83-year-old woman presenting with back pain. STIR, short T1 inversion recovery. Open full size image CASE B A 77-year-old woman presenting with back pain. FS , fat saturated; STIR, short T1 inversion recovery. Open full size image DESCRIPTION OF FINDINGS Case A: Approximately one-third loss of height of the L2 vertebral body is present from compression deformity of the inferior L2 endplate. Hypointense…

Disk Infection Versus Inflammatory/Degenerative Changes

CASE A A 58-year-old man with a history of heavy alcohol use, gastrointestinal bleeding, and prior bowel resection presenting with low back pain. FS, fat saturated; Sag, sagittal. Open full size image CASE B A 36-year-old man, who has had a previous diskectomy, presenting with low back pain. FS, fat saturated; Sag, sagittal. Open full size image CASE C A 42-year-old woman presenting with back pain…

Sacral Masses

CASE A A 71-year-old man with severe pain in his buttocks and lower back. Ax, axial; CT, computed tomography; Sag, sagittal. Open full size image CASE B A 20-year-old woman with progressive pain in her lower back and buttocks. Ax, axial; CT, computed tomography; Sag, sagittal. Open full size image CASE C A 52-year-old man with progressive lower back and left leg pain. Ax, axial; CT,…

Posterior Element Lesions

CASE A A 54-year-old woman presenting with back pain and left L3 radiculopathy. CT, computed tomography; STIR, short T1 inversion recovery. Open full size image CASE B A 19-year-old man presenting with right lower back pain. CT, computed tomography; FS , fat saturated. Open full size image CASE C A 19-year-old man presenting with dull left neck and shoulder pain. CTA, computed tomographic angiography; FS ,…

Nerve Root Enlargement

CASE A A 24-year-old woman with a history of neurofibromatosis type 1 presenting with a 3-month history of weakness and tremors in her right hand. Ax , axial; Cor , coronal; Sag , sagittal. Open full size image CASE B A 17-year-old male with foot deformity and scoliosis. Ax , axial. Open full size image CASE C A 59-year-old man presenting with pain and sensation of…

Cystic Intradural Extramedullary Lesions

CASE A A 42-year-old woman presenting with worsening lower extremity discomfort. ADC, apparent diffusion coefficient; Ax, axial; DWI, diffusion-weighted imaging; Sag, sagittal. Open full size image CASE B A 37-year-old man presenting for evaluation of low back pain for the past 3 to 4 years. Ax, axial; Sag, sagittal. Open full size image CASE C A 35-year-old man presenting with back pain. Ax, axial; Sag, sagittal.…

Multiple Enhancing Intradural, Extramedullary Lesions

CASE A A 40-year-old woman presenting with a 1-week history of worsening ascending numbness/tingling, urinary retention, saddle anesthesia, and decreased rectal tone. Sag, sagittal. Open full size image CASE B A 22-year-old man with a history of a known disorder. Ax, axial; Sag, sagittal. Open full size image CASE C A 42-year-old woman presenting with recurrent schwannoma proven by pathology and a brain magnetic resonance imaging…

Solitary Enhancing Intradural, Extramedullary Lesions

CASE A A 56-year-old woman with a history of chronic lower back pain and leg weakness who had fallen in the shower. Ax, axial; FS, fat saturated; Sag, sagittal. Open full size image CASE B A 28-year-old woman with a history of neurofibromatosis type 2. Ax, axial; Sag, sagittal. Open full size image CASE C A 78-year-old man presenting with right posterior thigh pain radiating from…

Enhancing Intramedullary Conus Lesions

CASE A A 3-year-old boy who has been limping and favoring the left lower extremity for approximately 1 month. Open full size image CASE B A 46-year-old man presenting with progressive bilateral lower extremity weakness and gait difficulty. Open full size image CASE C A 38-year-old man with von Hippel–Lindau disease presenting with bowel and bladder dysfunction. Open full size image CASE D A 29-year-old Brazilian…

Enhancing Intramedullary Spinal Cord Lesions

CASE A A 60-year-old woman presenting with progressive lower extremity numbness. Ax, axial; Sag, sagittal. Open full size image CASE B A 64-year-old woman with a history of von Hippel–Lindau disease. Sag, sagittal. Open full size image CASE C A 47-year-old man with a 1-year history of gradually progressive neck and hand pain and pain radiating into his arms. Ax, axial; GRE, gradient refocused echo; Sag,…

Basilar Invagination and Platybasia

CASE A Sagittal computed tomography image shows severe superior migration of the dens across the foramen magnum. Exaggerated cervical spine lordosis is also present. Open full size image CASE B Sagittal computed tomography image shows a nearly horizontal configuration of the clivus. In addition, the dens and atlas are positioned far superior to the level of Chamberlain’s line. Also note the diffuse osteopenia. Open full size…

Atlantooccipital and Atlantoaxial Separation

CASE A Sagittal T2 magnetic resonance imaging shows the anterior atlantooccipital ligament ( white arrow ), anterior arch of C1 ( black arrow ), dens ( magenta arrow ), apical ligament ( blue arrow ), tectorial membrane ( green arrow ), basion ( yellow arrow ), and opisthion ( red arrow ). Open full size image CASE B Flexion and extension lateral radiographs show normal alignment on…

Ecchordosis Physaliphora Versus Chordoma

CASE A A 70-year-old woman with a history of breast cancer presenting with diplopia. Ax, axial; CTA, computed tomographic angiography; Sag, sagittal. Open full size image CASE B A 44-year-old woman presenting with headache and dizziness. Ax, axial; CT, computed tomography; DWI, diffusion-weighted imaging; FS, fat saturated; Sag, sagittal. Open full size image CASE C A 19-year-old male who sustained trauma. Ax, axial; CT, computed tomography;…

Cyst with a Mural Nodule

CASE A A 51-year-old man with a history of headaches for 6 weeks now presenting with dizziness and nausea. Open full size image CASE B A 36-year-old Brazilian woman presenting with a 5-day history of progressive confusion, paranoid delusions, and magical thinking. Open full size image DESCRIPTION OF FINDINGS Case A: A supratentorial right temporal cyst with an enhancing mural nodule. No edema or other lesions are…

Epidermoid Versus Arachnoid Cyst

CASE A A 33-year-old woman with a history of chronic headaches. DWI, diffusion-weighted imaging; FLAIR, fluid attenuated inversion recovery. Open full size image CASE B A 74-year-old woman with a history of unsteady gait. DWI, diffusion-weighted imaging; FLAIR, fluid attenuated inversion recovery. Open full size image DESCRIPTION OF FINDINGS Scans demonstrate two different pineal region extraaxial masses roughly following CSF intensity: hypointense on T1-weighted images and…

Cerebral Subcortical Neurodegeneration

CASE A A 66-year-old woman presenting with left-sided motor deficits, including increased tone and loss of dexterity. PET, positron emission tomography. Open full size image CASE B A 59-year-old woman presenting with asymmetrically increased tone and bradykinesia on the left side. MRI, magnetic resonance imaging; PET, positron emission tomography. Open full size image CASE C A 62-year-old woman presenting with ataxia, dysarthria, saccadic breakdown of smooth visual…

Cerebral Cortical Neurodegeneration

CASE A A 72-year-old man presenting with a history of several years of primarily amnestic progressive cognitive deficits. PET, positron emission tomography. Open full size image CASE B A 71-year-old man presenting with progressive multidomain cognitive decline, gait and balance disturbance, and hallucinations. PET, positron emission tomography. Open full size image CASE C A 77-year-old man presenting with progressive behavior changes. PET, positron emission tomography. Open…

T2 Hyperintense Pontine Abnormalities

CASE A A 42-year-old woman presenting with orthostasis and hyponatremia. Ax, axial; DWI, diffusion-weighted imaging; FLAIR, fluid attenuated inversion recovery. Open full size image CASE B A 71-year-old man presenting with slurred speech and difficulty with hand-mouth coordination. Ax, axial; DWI, diffusion-weighted imaging; FLAIR, fluid attenuated inversion recovery. Open full size image CASE C A 34-year-old man presenting with choking episodes, right-sided weakness, and urinary incontinence.…

Hyperdense Cerebellum

CASE A A 45-year-old man with a history of a liver transplant presenting with fever and mental status changes. Ax, axial; Cor, coronal; CT, computed tomography; FLAIR, fluid attenuated inversion recovery; recon, reconstruction; Sag, sagittal. Open full size image CASE B An 11-year-old boy who was struck by a car. Ax, axial; Cor, coronal; CT, computed tomography; Sag, sagittal. Open full size image CASE C A…

Clivus Lesions

CASE A A 68-year-old woman with breast cancer presenting with a 3-month history of worsening cervical spine pain. Ax , axial; Sag , sagittal. Open full size image CASE B A 47-year-old man presenting with worsening headaches and double vision. Ax , axial; FLAIR , fluid attenuated inversion recovery; FS , fat saturated; Sag , sagittal. Open full size image CASE C A 31-year-old man presenting…