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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…

Skull Fracture Versus Sutures

CASE A A 9-month-old infant after a fall. CT, computed tomography; 3D, three dimensional. Open full size image CASE B A 45-year-old woman after a fall. Ax , axial; Cor , coronal; CT, computed tomography. Open full size image CASE C A woman of unknown age who sustained head trauma. Cor , coronal; CT, computed tomography; 3D, three dimensional. Open full size image CASE D A…

Lytic Skull Lesions

CASE A A 15-year-old girl with a history of panic disorder and migraines presenting with a change in mental status. Ax , axial; Cor , coronal; CT , computed tomography; Lat , lateral; Sag , sagittal. Open full size image CASE B A 69-year-old woman with a history of multiple paragangliomas and squamous cell and basal cell skin cancer presenting with a palpable left parietal calvarial…

Cranial Nerve Lesions

CASE A A 48-year-old woman with a history of lupus with severe vision loss. Cor, coronal; Sag, sagittal. Open full size image CASE B A 55-year-old man with long-standing left-sided facial weakness. Ax, axial; CT, computed tomography. Open full size image CASE C A 56-year-old man presenting with a 10-day history of left-sided facial weakness. Ax, axial. Open full size image CASE D A 63-year-old man…

Pineal Region

CASE A A 19-year-old Asian man presenting with headaches and visual difficulties. CT, computed tomography; DWI, diffusion-weighted imaging. Open full size image CASE B A 55-year-old woman presenting with headaches, nausea, and vomiting. CT , computed tomography; DWI , diffusion-weighted imaging. Open full size image CASE C A 24-year-old man presenting with excessive thirst. FS , fat saturated. Open full size image DESCRIPTION OF FINDINGS Case…

Suprasellar Cystic Lesions

CASE A A 19-year-old woman presenting with chronic visual changes, amenorrhea, and weight gain. Ax, axial; CT, computed tomography; DWI, diffusion-weighted imaging; Sag, sagittal. Open full size image CASE B A 70-year-old woman presenting after sustaining trauma. Ax, axial; CT, computed tomography; DWI, diffusion-weighted imaging; Sag, sagittal. Open full size image CASE C A 41-year-old man presenting with headaches. Ax, axial; CT, computed tomography; DWI, diffusion-weighted…

Fourth Ventricular Lesions

CASE A A 2-year-old boy presenting with unsteadiness and lethargy. Open full size image CASE B An 8-year-old boy presenting with emesis and headache. Open full size image CASE C A 45-year-old man with morning headaches and occasional nausea and vomiting. Open full size image CASE D A 32-year-old Latin American woman presenting with a severe headache. Open full size image DESCRIPTION OF FINDINGS Case A:…

Third Ventricular Lesions

CASE A A 54-year-old asymptomatic woman. FLAIR, fluid attenuated inversion recovery. Open full size image CASE B A 53-year-old woman presenting with dizziness, diplopia, and blurred vision. Open full size image CASE C A 32-year-old Latin American woman presenting with a severe headache. CT, computed tomography; DWI, diffusion-weighted imaging; FLAIR, fluid attenuated inversion recovery. Open full size image CASE D A 37-year-old man presenting with a…

Lateral Ventricular Lesions

CASE A A 20-year-old man presenting with a 2-month history of a worsening headache. ADC, apparent diffusion coefficient; Ax, axial; CT , computed tomography. Open full size image CASE B A 25-year-old woman presenting with a 2-week history of confusion (magnetic resonance imaging after a ventriculostomy for hydrocephalus). ADC, apparent diffusion coefficient; Ax, axial; CT , computed tomography; GRE, gradient refocused echo. Open full size image…