Neuroimaging Pearls from the MDS Congress Video Challenge. Part 2: Acquired Disorders

Abstract

The MDS Video Challenge continues to be the one of most widely attended sessions at the International Congress. Although the primary focus of this event is the presentation of complex and challenging cases through videos, a number of cases over the years have also presented an unusual or important neuroimaging finding related to the case. We reviewed the previous Video Challenge cases and present here a selection of those cases which incorporated such imaging findings. We have compiled these "imaging pearls" into two anthologies. The first focuses on pearls where the underlying diagnosis was a genetic condition. This second anthology focuses on imaging pearls in cases where the underlying condition was acquired. For each case we present brief clinical details along with neuroimaging findings, the characteristic imaging findings of that disorder and, finally, the differential diagnosis for the imaging findings seen.

Keywords: GAD65‐associated disease; MRI; Sjogren syndrome; diffuse large B cell lymphoma; dural arteriovenous fistula; gnathostomiasis; intracranial hypotension; toluene abuse.

FIG. 1

Case 1: Sequential axial FLAIR images demonstrating progressive atrophy of cerebellar hemispheres, prominence of cerebellar sulci and fourth ventricle and volume loss in middle cerebellar peduncle and pons.

FIG. 2

Case 2: Axial and sagittal T2 imaging of the brain demonstrates normal appearance of the gray and white matter. In particular, the corpus callosum is unremarkable. Sagittal T2 imaging of the cervical spine demonstrates hypersignal within the cord, extending from the mid‐C2 level to the C4‐5 level (>2 vertebral bodies in length). There is no significant cord expansion.

FIG. 3

Case 3: Axial FLAIR MRI brain at the level of the basal ganglia (A), the corona radiata (B); gadolinium‐enhanced T1‐weighted imaging showing enhancement of engorged vessels (dashed arrows) (C); axial T2‐weighted imaging with gadolinium showing small flow voids anterior to the brainstem and in the right temporal lobe from engorged vessels (small arrows), and large flow void from dilatation of the torcula, right transverse and sigmoid sinuses (large arrows) (D).

FIG. 4

Case 4: Axial T2 FLAIR MRI brain (A, B) and contrast‐enhanced sagittal T1 (C) showing inferior displacement of the brainstem, splenium of the corpus callosum and cerebellar tonsils with associated venous distension. Axial T2 post‐contrast MRI spine at the T6 level (D) demonstrating an epidural fluid collection suggestive of CSF leak.

FIG. 5

Case 5: (A, B, C): Pretreatment axial T2 and sagittal T1 post‐contrast images demonstrating two avidly enhancing mass lesions and extensive bilateral and symmetric edema within the globus pallidus, internal capsules, thalami, hypothalamus, midbrain and cerebral peduncles with obstructive hydrocephalus (see text for details) (D, E, F): Post‐chemotherapy axial T2 and sagittal T1 post‐contrast images demonstrating marked improvement in the pre‐treatment abnormalities.

FIG. 6

Case 6: Axial FLAIR (A), axial T2‐weighted imaging (B) and coronal T2‐weighted imaging (C) demonstrating hypointensity of thalami bilaterally and hyperintensity of the white matter (most notably of the posterior limbs of the internal capsules) and marked generalized atrophy. Coronal T2‐weighted imaging through the dentate nuclei (D) shows similar hypointensities in the dentate nuclei.

FIG. 7

Case 7: Axial T2‐weighted images demonstrating focal area of predominantly T2 hypointensity in the left midbrain and pons (see text for details) (A‐E); coronal gradient echo sequence demonstrating associated blooming artifact (F); (G): Axial T2‐weighted image at the level of the inferior olive showing olivary hypertrophy and hyperintensity (hatched arrow).