PROF.DR.K.H.NOORUL AMEEN’S UNIT

By Dr.S.Dhileepan 1st year pg

44 year old female Mrs.Rani, florist by occupation

c/o Weakness of Rt. UL & LL since 1 month

Deviation of angle of mouth to the Rt.side

No H/o trauma, LOC, seizures No H/o fever vomiting, Headache,

blurring of vision Not a hypertensive or diabetic H/o treatment for pelvic tuberculosis 10

years back

CVA with right hemiparesis and UMN type of facial

palsy.

Hetero intense in T1 & T2 and uniformly enhancing SOL in the left thalamus involving midbrain and left superior cerebral peduncle

MR Spectroscopy shows choline peak suggestive of high grade glioma

Brain tumourGliomaLymphomaMedulloblastomaEpendymomaMeningiomaSchwanomma

Tuberculoma Brain Abscess – Pyogenic Toxplasma Cystercercosis

HistoryFelix Block – 1946

PrincipleNuclear magnetic resonance using FOURIER

PrincipleUses proton of the methyl groupsWater and fat are suppressed

Hunter’s Angle

PPM Content Role Significance

0.9 – 1.4 Lipid Brain destruction Necrosis

1.3 Lactate Anaerobic Glycolysis

Acute strokeMito. Cytopathy

2.0 NAA Neuronal marker Mass lesion Dementia

2.2 – 2.4 Glutamate Glutamine

Neurotransmitter Bacterial Abscess

3.0 Creatine Energy metabolism Decreased in Stroke

3.2 Choline Membrane marker Cell turnover

3.5 Myo-inoisitol

Glial cell, Hormonal receptor

Increased in DownsWhite matter disease

TumourTumour or notType of tumour

Glial or non-glialGrade of tumour

High grade or low gradeSpread of tumourGuiding stereotactic biopsy and radiationResponse to treatmentRercurrence of the tumourRadiation necrosis

InfectionTubereculoma

Increased lipidDecreased choline

Pyogenic abscess Increased lipid & amino acidsNo choline

Toxoplasma, Cysticercosis & Cryptococcosis Increased lactate & lipid

Alzeimers DiseaseDecreased NAAIncreased Myo-inositol

Radiation necrosisIncreased lipidNo choline

Ischaemia Increased lactate / lipid

InfarctionIncreased lipid / lactate

Hepatic encephalopathyIncreased Glutamate a& Myo-inositol

Mitochondrial cytopathyIncreased lactate

White matter disease

Cannot differentiate primary tumour from secondary

MRS is useful in doubtful mass lesion brain

Let us utilise this facility which is available in our hospital judicially