aspnr interesting case session...aspnr interesting case session asnr 54 th annual meeting may 23,...
TRANSCRIPT
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ASPNR INTERESTING CASE SESSION ASNR 54th Annual Meeting
May 23, 2016
Erin Simon Schwartz, MD, President
Susan Palasis, MD, Vice-President
Ashok Panigrahy, MD, Secretary
Arastoo Vossough, MD, PhD, Treasurer
and
Laurence Eckel, MD, Treasurer
May 24, 2016
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IN WHAT YEAR WAS THE ASPNR FOUNDED?
A.1992
B. 1993
C.1994
D.1995
E. 1996
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IN WHAT YEAR WAS THE ASPNR FOUNDED?
A.1992
B. 1993
C.1994
D.1995
E. 1996
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ESS CASE 1
11 year old girl “progressively obtunded and vomiting”
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A. Subdural hygromas
B. Subarachnoid hemorrhage
C. Anemia
D. Iatrogenic effect
WHAT IS THE DIAGNOSIS?
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A. Subdural hygromas
B. Subarachnoid hemorrhage
C. Anemia
D. Iatrogenic effect
WHAT IS THE DIAGNOSIS?
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Additional history we found in the medical record:
Patient with seizures and rapidly declining mental status after local anesthetic (mepivicaine) injected for dental procedure
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INTRAVASCULAR LIPID ADMINISTRATION
• Lipid infusions increasingly being used to treat local
anesthetic systemic toxicity (LAST)
• Possible antidotal effect of intravenous lipid emulsion
on action of lipophilic drugs, including local
anesthetics, first discovered in 1962
• First case reports of success in human in 2006 • Controversial, however, as efficacy and safety not clearly proven
Lipid Rescue - Efficacy and Safety Still Unproven. Höjer J, Jacobsen D, Neuvonen PJ, Rosenberg PH. Basic Clin Pharmacol Toxicol. 2016 May 2. doi: 10.1111/bcpt.12607. [Epub] PMID: 27136445
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SP CASE 1
• 7 month old previously healthy full term male
• Found unresponsive in daycare
• Caregiver stated that the baby choked while taking the bottle
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Non C+ CT
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3D Volume rendering
+ Retinal hemorrhages
Negative skeletal survey
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T2 FSE T2 FSE FS
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TOF MRA TOF MRV
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A. Abusive head trauma
B. Vitamin K deficiency
C. Osler-Weber-Rendu syndrome
D. Menkes disease
WHAT IS THE DIAGNOSIS?
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A. Abusive head trauma
B. Vitamin K deficiency
C. Osler-Weber-Rendu syndrome
D. Menkes disease
WHAT IS THE DIAGNOSIS?
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OSLER-WEBER-RENDU SYNDROME
• Osler–Weber–Rendu syndrome (Hereditary hemorrhagic telangiectasia (HHT))
• Autosomal dominant genetic disorder that leads to abnormal blood vessel formation in the skin, mucous membranes, and organs
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OSLER-WEBER-RENDU SYNDROME
Digital Subtraction Angiography
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ABUSIVE HEAD TRAUMA SUBDURALS
T2 FSE
• Mixed intensity SDH
• Hematohygromas
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VITAMIN K DEFICIENCY
• Early (within 24 hrs), Classic (1-7 days of life), and Late (2-24 weeks)
• Neonates and infants at risk because Vit K transfer through the placenta is limited
T2 T1
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MENKES DISEASE
• X-linked recessive disorder of transmembrane copper (Cu) transport
• Rapid CNS degeneration
• Elastin collagen formation • Fragile, tortuous vessels
• Predisposition to ischemia
• Rapid brain atrophy leads to SDH
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WHO WAS THE FIRST ASPNR PRESIDENT?
A.Thomas P Naidich
B. Robert A Zimmerman
C.James A Brunberg
D.A James Barkovich
E. Patrick D Barnes
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WHO WAS THE FIRST ASPNR PRESIDENT?
A.Thomas P Naidich
B. Robert A Zimmerman
C.James A Brunberg
D.A James Barkovich
E. Patrick D Barnes
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AP CASE 1
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SECOND SIBLING
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WHAT IS THE MOST LIKELY DIAGNOSIS?
A. TORCH Infection
B. Zika Infection
C. Aicardi-Goutieres Syndrome
D. Chorioamnionitis
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WHAT IS THE MOST LIKELY DIAGNOSIS?
A. TORCH Infection
B. Zika Infection
C. Aicardi-Goutieres Syndrome
D. Chorioamnionitis
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AUTOSOMAL RECESSIVE PSEUDO-TORCH SYNDROME
• Phenotypic overlap with AGS (Aicardi-Goutieres syndrome)
• Failure to determine causative intrauterine infectious agent
• CSF leukocytosis with elevated interferon-alpha, neuropterins
• Hepatic transaminases and thrombocytopenia
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Child with right leg weakness
AV CASE 1
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WHAT IS THE DIAGNOSIS?
A. RF213 mutation (inherited moyamoya)
B. COL3A1 mutation
C. ACTA2 mutation
D. PHACES (unknown mutation)
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WHAT IS THE DIAGNOSIS?
A. RF213 mutation (inherited moyamoya)
B. COL3A1 mutation
C. ACTA2 mutation
D. PHACES (unknown mutation)
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ACTA2 MUTATION
Multisystem smooth muscle dysfunction Straight and narrow intracranial vessels – occlusions and ischemia
No moyamoya collaterals Small corkscrew distal vessels with tiny aneurysms
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HX of gastric dysmotility and congenital mydriasis. Several weeks of intermittent R hand numbness, progressively worsening slurred speech
and expressive aphasia
Courtesy of Michelle Silvera
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PHACES Posterior fossa malformations
Segmental hemangiomas
Arterial anomalies (narrowing, occlusions,
primitive connections, dilatation,
collaterals, anomalous course, later
aneurysms, etc.)
Cardiac defects
Eye abnormalities
Sternal or ventral defects
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WHO WAS THE FIRST FEMALE ASPNR PRESIDENT?
A.Tina Young Poussaint
B. Jill V Hunter
C.Nancy K Rollins
D.Patricia Davis
E. Mary K Edwards-Brown
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WHO WAS THE FIRST FEMALE ASPNR PRESIDENT?
A.Tina Young Poussaint
B. Jill V Hunter
C.Nancy K Rollins
D.Patricia Davis
E. Mary K Edwards-Brown
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12 year old obese female, headache for one week, nausea/vomiting for one day
ESS CASE 2
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A. Pseudotumor cerebri
B. Normal MRI
C. Acute infarction
D. Venous Sinus Thrombosis
WHAT IS THE DIAGNOSIS?
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A. Pseudotumor cerebri
B. Normal MRI
C. Acute infarction
D. Venous Sinus Thrombosis
WHAT IS THE DIAGNOSIS?
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PSEUDOTUMOR CEREBRI
• Lumbar puncture:
• Opening pressure: >60cm H20
• Headaches improved
• Discharged on: Methylprednisone taper, Acetazolamide, Gabapentin, Metoclopramide prn
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EXCEPT…
• One week after discharge, patient abruptly worsened
• 10/10 occipital headache, blurry vision, confusion, weakness, emesis, enuresis, encopresis, fall and seizure
• Sluggish 3mm pupils, bilateral papilledema, right CN VI palsy, hyporeflexia, unsteady gait, psychomotor slowing, and delayed, slurred speech
• Lumbar puncture:
• Opening pressure: >36cm H20
• Repeat 5 days later, opening pressure: 48cm H20
• All viral, toxicology, and rheumatological laboratory tests normal, aside from mild anemia
Raised papules on extremities
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Progressive deterioration with bulbar signs, urinary retention, acutely decreased responsiveness
40lb weight loss since onset of illness (two months)
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Over one week, mental status substantially declined
Minimally responsive to sternal rub, only able to
communicate by blinking, progressed to complete
unresponsiveness
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A. Inborn error of metabolism
B. Vasculitis
C. Pseudotumor cerebri
D. Toxic exposure
WHAT IS THE DIAGNOSIS?
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A. Inborn error of metabolism
B. Vasculitis
C. Pseudotumor cerebri
D. Toxic exposure
p-Dichlorobenzene: 2.8mcg/mL (normal = 0, reporting limit 0.020)
2,5-Dichlorophenol (DCB metabolite): 200mg/L (normal = 0, reporting limit 5.0)
WHAT IS THE DIAGNOSIS?
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LEUKOENCEPHALOPATHY SECONDARY TO
PARADICHLOROBENZENE TOXICITY
• Paradichlorobenzene in many forms of mothballs
• Patient kept many boxes in her poorly ventilated room for >3 years, “reminded her of her grandmother”
• Excessive inhalation or ingestion can cause a progressive leukoencephalopathy with ichthyotic rash and anemia, reports of intracranial hypertension
• Toxin stored & released from fat, acute worsening during catabolic stress (patient decompensated during stress & when NPO)
Twin Girls with Neurocutaneous Symptoms Caused by Mothball Intoxication.
http://www.nejm.org/doi/full/10.1056/NEJMc060329
Hernandez SH, Wiener SW, Smith SW. Case files of the New York City poison center:
paradichlorobenzene-induced leukoencephalopathy. J Med Toxicol. 2010
Jun;6(2):217-29
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• 3 yr old female with intermittent vomiting for 2.5 weeks
• Headache
• No fever
• Diagnosed with abusive head trauma at 5mos of age
T2 at 5mos
SP CASE 2
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3 years later
Ax Non C+ CT Cor Non C+ CT
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Ax T2 FSE
Ax T1 C+
Cor T1 C+
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DWI ADC
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A. Post-traumatic encephalomalacia
B. Intracranial epidermoid cysts
C. Malignant myxoid glial tumors
D. Abscesses
WHAT IS THE DIAGNOSIS?
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A. Post-traumatic encephalomalacia
B. Intracranial epidermoid cysts
C. Malignant myxoid glial tumors
D. Abscesses
WHAT IS THE DIAGNOSIS?
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MALIGNANT MYXOID GLIAL TUMORS
• Very rare
• Meningeal glial rests
• Low grade and high grade histology
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BRAIN ABSCESS
T2 DWI ADC T1 C+
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INTRACRANIAL EPIDERMOID CYST
T1 C+ DWI ADC
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WHAT IS THE NAME OF THE ASPNR BEST PAPER
PRESENTATION AWARD?
A. The Really Great Paper Award
B. The Golden Brain Award
C. The Derek Harwood-Nash Award
D. The ASPNR Gold Medal Award
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WHAT IS THE NAME OF THE ASPNR BEST PAPER
PRESENTATION AWARD?
A. The Really Great Paper Award
B. The Golden Brain Award
C. The Derek Harwood-Nash Award
D. The ASPNR Gold Medal Award
Derek Harwood-Nash was one of the fathers of
pediatric neuroradiology and a former President of
the ASNR. In addition to his many tremendous
contributions to our field, he was instrumental in
establishing the ABR CAQ in Neuroradiology. The
ASPNR is proud to honor his memory with this award.
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AP CASE 2
Ophthalmoplegia (non-painful)
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INTRAOPERATIVE
ULTRASOUND
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WHAT IS THE MOST LIKELY DIAGNOSIS?
A. Meningioma
B. Hemangiopericytoma
C. Hemangioendothelioma
D. Schwannoma
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WHAT IS THE MOST LIKELY DIAGNOSIS?
A. Meningioma
B. Hemangiopericytoma
C. Hemangioendothelioma
D. Schwannoma
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HEMANGIOENDOTHELIOMA (VASCULAR TUMORS)
• Differentiation from hemangioma based on infiltrative growth pattern and predominant Kaposi sarcoma-like content (fascicles of spindle cells)
• Tumor can also have fibrogenic thrombi in the capillaries, hemorrhage, areas of lymphangiomatosis
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5 year old with progressive mental decline,
swallowing problems, and weakness
AV CASE 2
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MRS, TE=135ms
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WHAT IS THE DIAGNOSIS?
A. Leigh syndrome
B. LBSL
C. Listeria with rhombencephalitis
D. Late-onset Alexander disease
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WHAT IS THE DIAGNOSIS?
A. Leigh syndrome
B. LBSL
C. Listeria with rhombencephalitis
D. Late-onset Alexander disease
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• Childhood or adolescent onset and slow disease course. Patients develop insidious pyramidal, cerebellar, and dorsal column dysfunction
• Recessive mutations in DARS2, which encodes mitochondrial aspartyl-transfer ribonucleic acid synthetase
MS van der Knaap et al. A new leukoencephalopathy with brainstem and spinal cord
involvement and high lactate. Ann Neurol. 2003
LEUKOENCEPHALOPATHY WITH BRAINSTEM AND SPINAL CORD
INVOLVEMENT AND HIGH LACTATE (LBSL)
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Steenweg et al. Neuropediatrics, October, 2012
Revised 2012 MRI criteria
Major criteria
Cerebral white matter (relative sparing of the subcortical white matter)
Dorsal columns and lateral corticospinal tracts of the spinal cord
Pyramids at the level of the medulla or decussation of the medial lemniscus
Minor criteria
Splenium of the corpus callosum
Posterior limb of the internal capsule
Superior and inferior cerebellar peduncles
Intraparenchymal part of the trigeminal nerve
Mesencephalic trigeminal tracts
Anterior spinocerebellar tracts in the medulla oblongata
Cerebellar white matter
LEUKOENCEPHALOPATHY WITH BRAINSTEM AND SPINAL CORD
INVOLVEMENT AND HIGH LACTATE (LBSL)
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LEIGH SYNDROME
SURF1 Mutation
Subacute necrotizing
encephalomyelopathy
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LISTERIA INFECTION AND RHOMBENCEPHALITIS
Listeria monocytogenes – gram+ bacillus
May lead to abscess
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ALEXANDER DISEASE
- GFAP Mutation
- Often large head
- Initially anterior white matter involvement
- Late onset disease often has brainstem
findings
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WHO WAS THE FIRST WINNER OF THE DEREK HARWOOD-
NASH AWARD IN PEDIATRIC NEURORADIOLOGY?
A. A James Barkovich, MD
B. Aria Tzika, PhD
C. Charles Fitz, MD
D. William Ball, MD
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WHO WAS THE FIRST WINNER OF THE DEREK HARWOOD-
NASH AWARD IN PEDIATRIC NEURORADIOLOGY?
A. A James Barkovich, MD
B. Aria Tzika, PhD
C. Charles Fitz, MD
D. William Ball, MD
Derek Harwood-Nash Outstanding Pediatric Neuroradiology Paper:
Tzika AA, Barnes PD (mentor), Tarbell NJ, Nelson SJ, Scott RM.
“Multivoxel proton spectroscopy of childhood brain tumors",
presentation at ASNR 33rd Annual Meeting, Chicago, IL. 1995
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ESS CASE 3
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A. Hunter Syndrome (MPS II)
B. Achondroplasia
C. Osteopetrosis
D. Morquio Syndrome (MPS IV)
WHAT IS THE DIAGNOSIS?
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A. Hunter Syndrome (MPS II)
B. Achondroplasia
C. Osteopetrosis
D. Morquio Syndrome (MPS IV)
WHAT IS THE DIAGNOSIS?
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23 Months
9 Years
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HUNTER SYNDROME MUCOPOLYSACCHARIDOSIS TYPE II
Imaging Findings:
Brain: Enlarged perivascular
spaces, delayed myelination,
white matter ↓T1/↑T2, volume
loss
Spine: Beaking of cervical
vertebrae, foramen magnum
and/or cervical stenosis,
cervical myelomalacia
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• Dysostosis with dwarfism, dental anomalies, corneal clouding, no direct CNS involvement (intellectually normal)
MORQUIO SYNDROME MUCOPOLYSACCHARIDOSIS TYPE IV
Spine Imaging Findings: Platyspondyly
with “ovoid” vertebral bodies, odontoid hypoplasia +/- cervical
subluxation, cervical stenosis and
myelomalacia
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ACHONDROPLASIA
• Most frequent form of rhizomelic dwarfism
Imaging Findings: Caudal
narrowing of interpediculate
distance, notch-like sacroiliac
groove, exaggerated lumbar
lordosis, cervical stenosis
Fetal CT courtesy of Teresa Victoria
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OSTEOPETROSIS
Imaging Findings: Hyperdense bones
AD I - calvarium with sparing of spine
AD II - skull base, spine, pelvis
AR forms - more aggressive with
systemic manifestations
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• 7 mos old girl with decreased leg movement since 4 mos of age
• Difficulty with urination and bowel movements
Sag T2 Sag T1 Sag T1 C+ Cor T2
SP CASE 3
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Ax T2
DWI ADC
SP CASE 3
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A. Plexiform neurofibroma
B. Myxopapillary ependymoma
C. Differentiating neuroblastoma
D. Atypical teratoid rhabdoid tumor
WHAT IS THE DIAGNOSIS?
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A. Plexiform neurofibroma
B. Myxopapillary ependymoma
C. Differentiating neuroblastoma
D. Atypical teratoid rhabdoid tumor
WHAT IS THE DIAGNOSIS?
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DIFFERENTIATING NEUROBLASTOMA
• Seven subtypes of neuroblastic tumors according to degree of neuroblastic maturation
MIBG
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MYXOPAPILLARY EPENDYMOMA
T1 T1 C+
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ATYPICAL TERATOID RHABDOID
T2 FSE
T1 C+
3 weeks later
post excision
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PLEXIFORM NEUROFIBROMA
ADC
DWI
STIR
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WHO PLAYED NIKOLA TESLA IN THE MYSTERY THRILLER DRAMA “THE
PRESTIGE”?
A. Johnny Depp
B. Robert Downey Jr.
C. David Bowie
D. Justin Timberlake
Question courtesy of Susan Palasis
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WHO PLAYED NIKOLA TESLA IN THE MYSTERY THRILLER DRAMA “THE
PRESTIGE”?
A. Johnny Depp
B. Robert Downey Jr.
C. David Bowie
D. Justin Timberlake
pubs.acs.org selvedgeyard.com
Fetal CT courtesy of Teresa Victoria
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Sagittal T2
Axial T2
AP CASE 3
Acute Flaccid Paralysis
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WHAT IS THE MOST LIKELY DIAGNOSIS?
A. Spinal Cord Infarct
B. Demyelination Lesion
C. Enterovirus myelitis
D. Metastatic disease
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WHAT IS THE MOST LIKELY DIAGNOSIS?
A. Spinal Cord Infarct
B. Demyelination Lesion
C. Enterovirus myelitis
D. Metastatic disease
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ENTEROVIRUS D68 AND CNS DISEASE
2005 EV-D68 isolated from CSF in “a young adult” with flaccid paralysis1
2008
2014
2012 EV-D68 isolated from nasal swabs of two children w “polio-like” syndrome2
1Khetsuriani et al, MMWR, 2006 2Roux et al, Neurology. 2014;83(10):Supplement P3.335.
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0 2 4 6 810
12
14
16
18
20
22
24
26
28
30
32
33 - 73
0
2
4
6
Age (years)
Aff
ecte
d in
div
idu
als
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TAKE HOME POINTS
• Enterovirus myelopathy has fairly nonspecific imaging features • T2 prolongation in central gray, cervical
>thoracolumbar, variable nerve root enhancement
• Consistent clinical features help make diagnosis of Acute Flaccid Myelitis
• Motor recovery is usually incomplete
• Enterovirus species are the predominant AFM associate
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AV CASE 3
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WHAT IS THE DIAGNOSIS?
A. Fetal Teratoma
B. NF-1 with optic pathway glioma
C. Pallister-Hall syndrome
D. Orofaciodigital Syndrome
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WHAT IS THE DIAGNOSIS?
A. Fetal Teratoma
B. NF-1 with optic pathway glioma
C. Pallister-Hall syndrome
D. Orofaciodigital Syndrome
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PALLISTER-HALL SYNDROME
Hypothalamic hamartoma (5% of all cases)
Polydactyly - syndactyly
Anal atresia
Renal anomalies
Bifid epiglottis
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PALLISTER-HALL SYNDROME
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FETAL INTRACRANIAL
TERATOMA
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WHAT WAS THE FIRST NEUROIMAGING TECHNIQUE
DEVELOPED? A. Pneumoencephalography
B. Functional MRI
C. Human Circulation Balance
D. Cerebral angiography
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WHAT WAS THE FIRST NEUROIMAGING TECHNIQUE
DEVELOPED? A. Pneumoencephalography
B. Functional MRI
C. Human Circulation Balance
D. Cerebral angiography
Italian neuroscientist Angelo Mosso who
invented the 'human circulation balance',
which could non-invasively measure the
redistribution of blood during emotional
and intellectual activity.
Sandrone, S.et al. (2014). Weighing brain activity with the
balance: Angelo Mosso’s original manuscripts come to light.
Brain, 137(2), 621–633.
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Former 26 week premature infant, now 5 months old, paraspinal lesion incidentally detected on
Chest CTA
ESS CASE 4
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Sag T2 Sag T1
Cor STIR
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Ax T2
Post Gad T1 Fat Sat
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I123 MIBG/CT Fusion
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I-123 MIBG SPECT/CT SCAN CAN BE NEGATIVE IN NEUROBLASTOMA
A. True
B. False
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I-123 MIBG SPECT/CT SCAN CAN BE NEGATIVE IN NEUROBLASTOMA
A. True
B. False
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I-123 MIBG SPECT/CT FOR NEUROBLASTOMA
Primary Tumor:
• Sensitivity 67-100%
• Specificity 68%
Metastases:
• Sensitivity 79-100%
• Specificity 33-89%
~10% False Negative Rate
Bleeker G, et al. 123I-MIBG scintigraphy and 18F-FDG-PET imaging for diagnosing neuroblastoma. Cochrane Database Syst Rev. 2015 Sep 29;9:CD009263
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WHAT IS THE DIAGNOSIS?
A. Neuroblastoma
B. Hematoma
C. Hemangioma
D. Neurenteric Cyst
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WHAT IS THE DIAGNOSIS?
A. Neuroblastoma
B. Hematoma
C. Hemangioma
D. Neurenteric Cyst
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INFANTILE CAPILLARY HEMANGIOMA
• Most common soft tissue tumor of infancy
• Incidence has steadily increased over past 35 years, correlating with decreasing gestational age at birth as well as birth weight
Anderson KR, et al. Increasing incidence of infantile hemangiomas (IH) over the past 35 years: Correlation with decreasing gestational age at
birth and birth weight. J Am Acad Dermatol. 2016 Jan;74(1):120-6
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GASTRULATION
From Carlson, Human Embryology and Developmental Biology, 2014
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NEURENTERIC CYST
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• 6yr old with increasing seizures
• Fever
Ax T2 Cor T2
SP CASE 4
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A. Hypertrophic olivary degeneration (HOD)
B. Adrenomyeloneuropathy
C. Enterovirus rhombencephalitis
D. Neuromyelitis optica (NMO)
WHAT IS THE DIAGNOSIS?
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A. Hypertrophic olivary degeneration (HOD)
B. Adrenomyeloneuropathy
C. Enterovirus rhombencephalitis
D. Neuromyelitis optica (NMO)
WHAT IS THE DIAGNOSIS?
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HOD SECONDARY TO MITOCHONDRIAL DISORDER
• Hypertophy and increased signal in the inferior olivary nucleus
• Palatal tremor
• Rare in children but can be seen following posterior fossa surgery
• Disruption of triangle of Guillain-Mollaret
Goyal M et al. AJNR 2000
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ADRENOMYELONEUROPATHY (AMN)
Axial T2
• Form of adrenoleukodystrophy • Long chain fatty acids deposited damage myelin
• Symmetric signal abnormalities along corticospinal tracts
• Atrophy
Courtesy of TAGM Huisman and A Poretti
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ENTEROVIRUS RHOMBENCEPHALITIS
Sag T1 Ax T1 Ax T2
• Fever, flaccidity
• Dorsal brainstem, dentate nuclei, cord gray matter
Courtesy of TAGM Huisman and A Poretti
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NEUROMYELITIS OPTICA (NMO)
FLAIR Ax T2 Sag T2
• 70% test positive for aquaporin 4
• Involve periventricular structures,
periaqueductal gray, medulla at
obex
• Optic neuritis
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IN WHAT YEAR WAS THE FIRST JOINT ASFNR-ASPNR
SYMPOSIUM?
A. 2000
B. 2004
C. 2008
D. 2012
E. 2016
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IN WHAT YEAR WAS THE FIRST JOINT ASFNR-ASPNR
SYMPOSIUM?
A. 2000
B. 2004
C. 2008
D. 2012
E. 2016
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AP CASE 4
ACUTE RIGHT HEMIPARESIS RECENT BIOPSY OF SKIN LESION
Thanks to Dr Andre Furtado
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ONE YEAR LATER
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WHAT IS THE MOST LIKELY DIAGNOSIS?
A.Diffuse Axonal Injury
B. Hereditary Hemorrhagic Telangiectasia (HHT)
C. Sturge-Weber
D. Parry-Romberg Syndrome
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WHAT IS THE MOST LIKELY DIAGNOSIS?
A.Diffuse Axonal Injury
B. Hereditary Hemorrhagic Telangiectasia (HHT)
C. Sturge-Weber
D. Parry-Romberg Syndrome
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AJNR 36:1355-61, Jul 2015
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PARRY-ROMBERG SYNDROME
• Rare, self-limiting progressive hemiatrophy of the face (but brain abnormalities can present first)
• Skin lesion = Scleroderma
• Intracranial findings: parenchymal calcifications, hemorrhage, white matter lesions, atrophy
• Etiology unknown (autoimmune?)
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Intermittent exotropia, headache, and
papilledema
T2 T1 Gad T1
AV CASE 4
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SWI Magnitude DWI ADC SWI Phase
T2
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WHAT IS YOUR DIAGNOSIS?
A. Choroid plexus carcinoma
B. Supratentorial PNET
C. Meningioma
D. Cavernous Malformation
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WHAT IS YOUR DIAGNOSIS?
A. Choroid plexus carcinoma
B. Supratentorial PNET
C. Meningioma
D. Cavernous Malformation
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GIANT CAVERNOUS MALFORMATION
(CAVERNOMA)
T2 T1 Gad T1
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INTRAVENTRICULAR MENINGIOMA
T2 T1 Post CT
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SUPRATENTORIAL PNET
T2 DWI T1 Post T2* GRE
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CHOROID PLEXUS CARCINOMA
T2 DWI
T1 Post FLAIR
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WHAT WAS YOUR FAVORITE SESSION AT THE 2016 ASNR
ANNUAL MEETING?
A. Session 2A
B. Lunch
C. Session 3D
D. The Annual Business Meeting
E. THE ASPNR INTERESTING CASE SESSION
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WHAT WAS YOUR FAVORITE SESSION AT THE 2016 ASNR
ANNUAL MEETING?
A. Session 2A
B. Lunch
C. Session 3D
D. The Annual Business Meeting
E. THE ASPNR INTERESTING CASE SESSION
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www.aspnr.org
Facebook Group:
ASPNR