Bilateral persistent primitive hypoglossal artery presenting with hemiplegia.

The manuscript describes an unusual vascular anomaly. Persistence of carotid-vertebrobasilar anastomosis is a rare occurrence with presence of bilateral hypoglossal arteries (HAs) rarer still. We present a case of bilateral persistent HAs with hypoplastic vertebral arteries which end into posterior inferior cerebellar arteries.

Fractures of the posterolateral maxillary sinus: a masticator space blowout injury?

Background And Purpose: Segmental, depressed fractures of the posterolateral maxillary sinus may occur as a result of trauma to the masticator space, previously described in association with mandibular fractures. The authors hypothesize that the fracture is due to a transient increase in pressure in the masticator space (blow out) and therefore should be seen in association with other regional fractures.

Materials And Methods: Injuries of the masticator space were retrospectively identified by searching the imaging database from January 2014 to November 2014 for keywords that would identify regional trauma.

Magnetic Resonance Imaging of Acute Stroke.

Neuroimaging plays a critical role in the management of patients with acute stroke syndrome, with diagnostic, therapeutic, and prognostic implications. A multiparametric magnetic resonance (MR) imaging protocol in the emergency setting can address both primary goals of neuroimaging (ie, detection of infarction and exclusion of hemorrhage) and secondary goals of neuroimaging (ie, identifying the site of arterial occlusion, tissue characterization for defining infarct core and penumbra, and determining stroke cause/mechanism). MR imaging provides accurate diagnosis of acute ischemic stroke (AIS) and can differentiate AIS from other potential differential diagnoses.

Face and Neck Infections: What the Emergency Radiologist Needs to Know.

An overview of the imaging of face and neck infections is presented. Most of the imaging presented is contrast-enhanced computed tomography. The emphasis of this presentation is to enable the emergency radiologist to accurately diagnose face and neck infections, to effectively communicate the imaging findings with emergency physicians, and to function as part of a team offering the best care to patients.

Bayesian estimation of cerebral perfusion using reduced-contrast-dose dynamic susceptibility contrast perfusion at 3T.

Background And Purpose: DSC perfusion has been increasingly used in conjunction with other contrast-enhanced MR applications and therefore there is need for contrast-dose reduction when feasible. The purpose of this study was to establish the feasibility of reduced-contrast-dose brain DSC perfusion by using a probabilistic Bayesian method and to compare the results with the commonly used singular value decomposition technique.

Materials And Methods: Half-dose (0.

Multidetector CT of temporal bone fractures.

Temporal bone fracture is a relatively common finding among trauma patients. Before the development of high-resolution multidetector computed tomography (MDCT) imaging, fractures of the skull base and temporal bone were a challenge to diagnose clinically. With current imaging technology, most such fractures are easily detected, and the challenge now lies in predicting the severity of injury and possible complications.

Decreased cerebellar activity on FDG PET/CT secondary to diffuse idiopathic cerebellar calcification.

Cerebellar hypometabolism on FDG PET has been described in several conditions, for example, chronic alcohol abuse, antiepileptic medication use, multiple system atrophy, and cerebellar infarction. Corresponding cross-sectional examination is paramount in distinguishing possible etiologies because each condition has a relatively characteristic appearance. We present a case of an asymptomatic patient with diffuse cerebellar hypometabolism found incidentally on FDG PET/CT performed for suspected recurrence of gastric carcinoma.

Updated imaging of traumatic brain injury.

Computed tomography (CT) and magnetic resonance (MR) play important roles in the evaluation of traumatic brain injury. Modern CT scanners allow for rapid and accurate diagnosis of intracranial hemorrhage and mass effect and allow the efficient implementation of emergent CT angiography. Newer sequences, such as gradient recalled echo, susceptibility-weighted imaging, and diffusion-weighted imaging, can provide greater sensitivity for specific types of diffuse posttraumatic brain injury.

Lemierre syndrome: report of five new cases and literature review.

Lemierre Syndrome (LS) is relatively rare, and its clinical features are potentially confusing. Without proper therapy, LS is associated with significant morbidity and is potentially fatal. Recognition of the imaging features of LS in the chest and the neck may permit a timely diagnosis and lead to prompt institution of appropriate therapy.

Imaging of orbital trauma.

Assessing traumatic orbital injuries is an important challenge for radiologists; this assessment is even more difficult when the orbital injury is associated with injuries involving multiple organs. Common posttraumatic orbital injuries include anterior chamber injuries, injuries to the lens, open-globe injuries, ocular detachments, intraorbital foreign bodies, carotid cavernous fistula, and optic nerve injuries. Radiographic examination of the orbits is rarely performed.

Longitudinal evaluation of apparent diffusion coefficient in children with neurofibromatosis type 1.

Objectives: Foci of T2-prolongation in both supra- and infratentorial brain in neurofibromatosis type-1 (NF1) patients have been called hamartoma-like NF1 lesions (HLL); however, their behavior is not consistent with this definition. Diffusion-weighted imaging has been used to study structure and cellularity of intracranial lesions. We applied this technique to characterize HLL as they change with time in pediatric patients.

Sinonasal imaging: malignant disease.

The clinical presentation of sinonasal malignancy overlaps that of more common benign inflammatory disease. For this reason, unsuspected malignant lesions are often first recognized on the screening CT exam. We will focus on the initial CT appearance of various malignancies and discuss the goals of imaging including the use of MR.

Rehabilitation outcome of individuals with nontraumatic myelopathy resulting from spinal stenosis.

A study was undertaken of 46 patients (19 cervical and 27 lumbar) admitted to an inpatient rehabilitation unit following surgical decompression for myelopathy or cauda equina syndrome resulting from spinal stenosis (SS). Individuals with SS represented 16 percent of all spinal cord injury (SCI) admissions. When compared to patients with traumatic SCI, patients with SS were significantly (t-test, p < .

Sinonasal anatomy.

Recent advances in paranasal sinus imaging have been driven by the development of functional endoscopic sinus surgery. The goal of most sinus imaging is to provide a surgical road map delineating the anatomy, defining the obstructing lesions, and noting anatomic variations that may predispose to operative complications. We review the embryology and development of the nose and paranasal sinuses; review the radiographic anatomy of the adult sinuses and their drainage pathways; and point out variations in the normal anatomic pattern, concentrating on those variations that are significant for the functional endoscopic sinus surgeon.

The pathological globe: clinical and imaging analysis.

Categorizing globe lesions based on clinical presentation can suggest a short list of diagnostic possibilities. Imaging of the globe with ultrasound, CT and MRI is presented with a focus on key differential points. The radiologist can then efficiently tailor the examination in order to differentiate among the diagnostic possibilities.

Cortical and subcortical T2 shortening in multiple sclerosis.

Low signal intensity on long-repetition-time MR sequences has been observed in deep gray matter structures in patients with multiple sclerosis. This T2 shortening most likely represents a nonspecific degenerative process. We recently observed T2 shortening in the pericentral cortical gray matter and subcortical white matter in a patient with severe multiple sclerosis and we postulate that this represents an additional manifestation of neural degeneration.

Hyperactive pectoralis reflex as an indicator of upper cervical spinal cord compression. Report of 15 cases.

Myelopathy from cervical spondylosis is often accompanied by hyperreflexia of the upper-extremity deep tendon reflexes (DTRs). Reflexes such as the pectoralis jerk and the deltoid jerk may only be apparent in the context of hyperreflexia. Although the nerve roots involved in the reflex arcs are well described, levels of cervical spinal cord compression that lead to the hyperreflexia are not as clear.

Intrasellar presentation of a cystic optic chiasm fibrillary astrocytoma.

The unusual radiologic presentation of an optic chiasm fibrillary astrocytoma extending through and expanding the diaphragma sellae in an 8-year-old male is described. The child presented with decreased vision in the right eye. Magnetic resonance imaging demonstrated a cystic intra- and suprasellar mass, isointense on T1WI and hyperintense on T2WI, that enhanced with contrast.

Neuro-Behçet's disease.

We are reporting a case of Behçet's disease without vasculitis, but with acute neutrophilic inflammation which involved the brain and other organs. The patient exhibited waxing and waning neurological deficits which were unresponsive to treatment. The neuroradiologic findings simulated those of multiple sclerosis.

Extrapontine myelinolysis of the basal ganglia without central pontine myelinolysis.

Since the first descriptions of central pontine myelinolysis (CPM) were put forth it has become evident that myelinolysis may not be exclusively restricted to the pons. In many cases myelinolysis may share other brain regions, while in still others the pons may not be affected at all, as in the present case of pure basal ganglia myelinolysis. Regardless of geographic location, too rapid correction of hyponatremia has been invoked as the triggering mechanism which leads to both CPM and extrapontine myelinolysis (EPM).

Updated management strategy for patients with cervical osteophytic dysphagia.

Anterior cervical osteophytes impinging upon the pharynx or esophagus constitute a rare cause of dysphagia. In severe cases, surgical removal of these osteophytes can provide symptomatic relief. We describe a patient of this type who failed to improve postoperatively, only to be found subsequently to have a carcinoma of the base of the tongue.

Gadolinium-enhanced magnetic resonance imaging of the facial nerve in herpes zoster oticus and Bell's palsy: clinical implications.

Gadolinium-enhanced magnetic resonance imaging was used in the evaluation of the facial nerve in four patients with idiopathic facial paralysis and six with herpes zoster oticus (HZO). Enhancement of the facial nerve was seen in all patients with Bell's palsy, and 50 percent of patients with HZO. The most consistent area of enhancement in both disorders involved the premeatal and labyrinthine segments.

Magnetic resonance imaging: improved patient tolerance utilizing medical hypnosis.

Magnetic Resonance Imaging (MRI) is a medical diagnostic procedure which requires a patient to be placed supine into the cylindrical bore of a powerful magnet for approximately one hour. The patient's arms are usually against the sides of the magnet bore with a 3" to 10" space between the patient's face and the top of the magnet bore. This enclosure induces panic and claustrophobic responses in 1% to 10% of the patients undergoing the MRI procedure.

Slowly progressive facial paralysis due to vascular malformation of the brain stem.

Slowly progressive facial paralysis is suggestive of a diagnosis other than Bell's palsy. A case of slowly progressive facial paralysis caused by a cavernous angioma of the brain stem is presented. The classification of vascular malformations of the central nervous system is described with emphasis on the MRI appearance of these lesions.