Top 3 Differentials in Neuroradiology

626 Pages·2015·46.139 MB·English

by  William T. O'Brien

Top3 Diffe rentiianl s
Neuroardiology
A CasRee view
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Dedicaitnem de moryo f
RobertL MealsDO,
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Contents
ForeworclR ibyc haEr.d Latchaw vii
Preface
viii
Aclmowledgments ix
Secti1o.Bn r ain
SubsectliaCo.on n geniatnadDl e velopmental 2
SubsectlibAo.tn t enuaatnidoS ni gnAabln ormality 44
SubsectlieMo.an s seasn dM assliLkee sions 110
SubsectIidVo.an s culaatnudrC ee rebrosFpliuniSadpl a ces 186
SectiIoLnH eada ndN eck
SubsectHiao.cn a lvarainudmS kulBla se 260
SubsectIiIobTn.e mporBaoln e 296
SubsectIiIoSeni. n onasal 330
SubsectIiIodMn.a xillofacial 362
SubsectIiIoNene. c k(i ndudsipnagc es) 382
SubsectHifOo.rn b its 444
SectiIoDnS. p ine 484
Indexo fD ifferentDiiaagnlo sesby, Case 607
Indexo fKey Findi� 612
vi
Foreword
Unique/ derifrvoem m ultidpilaeg nocsatitce goFroisreo sm.ea ppear­
ancesh,e e veni ndudesso meu ncommobnu tp otentially
lbati st heb eswotr d to describTeo p3 DijJerentials in importcoannsti derations ("AdditiCoonnasli dDeiraag­nostic
NeuroradioblyWo igyl liTa.m O'Brieni-nui ntaispq pureo actiho ns"t)h,up sr ovidmionrget hajnu stth repeo ssibifolri ties
tot hec linipcraalc tioœf n euro-imaagnidnu gn,i quieni ts casewsi tmho ren onspecfiinfdiicn Hgesfi .n isheeasc cha se
approatcoeh d ucatiiontn h irsa piedxlpya ndsiunbgs peci.a lwtiytdhi nicaanldi magi"nPge arwlhsi,c"ph r oviqduei cdki f­
Thetr aditiocnlailn ipcraalc toifœa neurolongeiusrto,­ ferentiating fHeeaa tlusprore osv.i dsoemse s elecrteefd-e r
surgeoonr,t hopesduircg eon-apnhyys icioarnd erian g encefosr m orei n-derpetahd ionngt het opic.
neuro-imageixnagm inatitoone -viasl utahteep atienhti'ss­ Sornei magianpgp earawnictehsei anc she ctiaornue n ique,
toriyn co njunctwiiotnsh ignasn ds ymptomcso,rn eta a withoduitf ferential adnidan gontho asveisan Tgo p3 ;t hey
probabcloen clusainodtn h,e rne queasnti magisntgu dtoy arcea lled "Aunt DMrOi.'n Bnriiecoesnn.s "i dearn su mbeorf
confiromrd entyh actl inicocnacll usion. thesteob efu ndamenttaotl h ken owledbgaeso eft hset udent,
Thec linipcraalc tiocfea r adioloigniistitar lelqyu itrhees sat heayr per esenattte hdee ndo fe acshe ctiEoanc.hh a sa n
recognitoifao co nm binatoifof ni ndionnga sni magisntgu dyex tensidvies cusrseigoanrd ipnagt hophysiaonldco hgya rac­
withtihne s tatecdl iniccoanlt eTxhti iss fo llowedb yt he teriismtaigci anpgp earanacleosnw,gi tshe lecrteefde renœs,
iteraticvoem pariosfot nh esfien dintgose xamplfreosm similtaotr h afto unwdi tthh cea sehsa viTnogp 3 d ifferential
diagnocsattiecg oriinecsl,u dmiansgs edse,m yelinadtiisn­gp ossibilities.
easeiss,c hemia, infection,d idseegaesetenc,eT. rh aitisv eH ow didD r.O 'Briveanl idhaitsTe o p3 choicweist sh o
iteraptirvoeœ smsa yb em entaolra ctuarlelqyu icormep ari­manyv ariaepdp earanicnde isv erse clinicBayl contexts?
sonw ithp ublisexhaemdp leTsh.e r esuilsta differentiadlo inexgt ensirvees eaarscto h t hem ostc ommond iagnoses
diagnotshiamstay variyn s pecificiatnydd eptOhn.e m ight fora g ivefinn dinbgyc; o nsulwtiitnmhga ny radiolowghios ts
litshttoe p t hrpeoes sidbilaeg noosreo sn,eco uldl itshtme o st subspeciianln iezuer oradihoelaodgya ,n dn eckr adio,l ogy
likelytwhiatwthh icihst hmeo sdta ngeraonudts h umsu sbte and spinarla dioloagnyd; b y incorporaetnitnigti es
excludeda,l onwgi tohn et hawto ulbde e astoy exc ludew ith thatte ntdo b ef avoriintge esn eraanlds ubspecbioaalrtyd
mores tudies. examinations.
Howd owetr aditioendaulclaytr ee aado efnr e uro-imaginHgo w wiltlh ibso okc hangheo wwe practiacned t each
studiWees7 u sualelnys urteh atth en ovicer eadhears s een neuro-imalgiti snv gi?tt ahlan te uro-imagehrasvi en grained
examplefrso mt hev arioduisa gnocsatitecgo riweist whh ich int hebirra itnh bea sciacte goroifen se uropathosloto hgya,t
wed eaaln,d h asl eamehdow diseawsietsh eianc cha tegoryt hecya nb es urteh atth ecya vearip lo tentdiiasle acsaet ego­
diffefrro mt hosieno thecra tegorTiheeso .r ganizaotifoo unr riewsh enc onfrontewdi tha n unknownc aseH.o wever,
bookasn do urt eachsiensgs iiostn ysp icbaalsleyd uspuocnh O'Briaepnp'rso accahne asiblesy u perimpoonst ehda bta sic
categoriNeeso:p lasCmosn,g eniDtiasle aIsnef,e ctieotcn.s ,k nowledogfde i seaosreg anizaltitio snf .a st, acacnudr ate,
Howevewrh,a th appenwsh ent hei mageirsc onfrontreedm ovtehse p otentiatlh atth er eadweirl ble s loweddo wn,
witahn " unknowan fi,n"d intgh adto enso tfit easiilnyto tryintgoe nsutrhea atic la tegoarriceeo sv ered.a pTphriosa ch
oneo ft hec ategortoi ewsh ichhe o rs heh asb ecomes o providae wsa yt obe "compleitend" e velopdiinffegr ential
accustomedU?n fotrunat,ee lvyen thotuhgeih m ager hdaisa gnorsaepsi dalnyda ccurya.t el
leametdh ea ppearanocfte hsem ajoriotyfe ntitiweist hin 1f ounrde aditnhgib so otko b ea ojyO. nec ana pproaicbthy
a givecna tegoorfdy i seatsheefi, n dindgo esn otte llt he playitnhge stuvdieenwti,en agc hi magaes a nu nknown,
imagetrow hiccha tegoriytb elongSso!t, h ei magemru st determinwihnagtt hem ostp rominefinntd inigsa ,n dt hen
nows earcthh ec ategoricbaalsleteydx tboofkosra "lookg ivionnge o'wsn T op3 .Fr an,kt lhyiissa b oonko tj usfotr t he
alikweh,i"c ihsv ertiym e-consumainndmg a yn ote veben residoerfn etl lbouwto, n et hawti lgli vaen ya cademfaiccu lty
successful. membearp ositilveea rning expjeurslitie ktnehœ eo, n et hat
DrO.' Briaepnp'rso atac bho tthh ec linipcraalc tiacnedt he 1h adl
educatioofnn euro-imaigsiq nugi tuen iquaem ongstth e
textbo1oh kavses eeonv emra nyye arsa sa n euroradiologist
Heh asd ividtehdib so oikn ttoh resee ctionBrsa:i Hne,a da nd RichaErd.L atchaMwD,
Necka,n dS pinWei.t hiena cshe ctihoecon n,œ ntrateso nt he ProfessoorfR adiology
mosatp parenitm agifinngd ingw(ist)h tihne prescelnitinn­g NeuroradiolSoegyc tion
icalc onteaxntdg, i vtehse" To3p"p otentidaila gnofsoetrsh at UniversoiftyC aliforniDaa,v iMse dicCaeln ter
appeara(tn hcea "tg amuti"n)c,l udeinntgi ttiheamstay well SacramenCtaol,ifo rnia
vii
Preface
Iti sa distinpclte asutrope r eseTonpt 3 Differentiailns facmta,n yi llustrcaatsiehvsae v ea finald iagnotshiast
NeuroradiolAo Cgya:s Ree vieDwe.v elopain negu roradiolwooguyl ndo tb ec onsideirnet dh eT op3 for thep articular
versiooftn h eo rigi"nTaol3p " b ookT,o p3 Differentiianl sg amutI.n stetahdep, r imaariym o ft heb ookis t og enerate
Radiolhoagyd,b eeann a spiraotfim oinn es incietp su blicaa­ndh avaen u nderstanodfai rnega sonalbilsoetfg amut­
tioinn2 0O1.T h issu bspedvaelrtsyi iospn r imarily desbiagsnededid ff erentriaatlhset rh ant oo btaitnh e" correct"
fors eniroard iolroegsyi dents, neuroradainodl oagnys wfeerl.l ows,
starfafd iolopgriesptasr foirnt gh en euroradipoolrotgiyo n As witthh ee arlTioepr3 DifferentiinaR lasd ioliotgyi ,s
ofi nitiaanldr ecertifibcoaatiroexdna minatiohnosw;e veirt, i mporttoa nrte alizet htedh iaffetr entiaanldds i scussairoen s
maya lspor ovues efuflo rd iniciaanndss urgeownhso baseodn t hek eyfi ndinogrg amuatn dn otn ecessatrhiel y
routinuetliyl niezuer oimaging. illustrcaatsietvshe aa tr es hownT hiissby desigbne,c au1s e
Thibso oki so rganiiznetdto h remea ins ectiobnrsa:i n,f elittw oulbde m oreh igh-ytoi ebladst eh ed ifferenatnida ls
heaadn dn ecka,n ds piniem aginagn;df urthdeirv idiendt o discussointo hneso vergaalmlu t/kefyi ndirnagt htehra tnh e
subsectbiaosneusdp ona natomrieeg ioornp atterno fi mag­illustrcaatsiepv ree senteHdav.i nga n understanodfi ng
inga bnormalEiatcyhs. e ctiobne ginwsi tha serioefs gamut-badsieffde rentiwaillalsl loown et os ubsequently
unknownd ifferentiacla-sbeaasns dee dn dwsi t"hR oentgent ailtohrIe i osftd ifferenfotria anlycs a steh aitss howwni thin
dassicwsh,i"ca hr ec asewsi tihm agifinngd incghsa ractetrh­eg amutw,h erebaass itnhge d ifferenotinat lhses elected
istiocfa s ingdliea gnosis. imagewso ulbde m ore limiteidnte rmso ff utuurtei lity.
Ont hefir spta goef e accha sree,a dearrsep resenwtietdh Givetnh e veavsotl,v fiienlgod fn euroimagtihnibgso, o iks
imagefrso ma nu nknowcna sael,o nwgi tahc linihciastto ryn otm eantto b ea c omprehenrsefievree nbcoeo kr;a thietir s,
anda ni maglee genTdh.e imaagreems e antto i llustar amteea ntot servaesa h igh-yrieevlidfe owbr o arpdr eparation,
keyi magifnign diwnhgi,c ihst heb asifsot rh es ubsequenatsw elals a quicrkefe rencfoer c linipcraalc tWiicet.ht hese
casdei scussTihoens .e conpda geI istthse k eyi magingi ntentiionmn is ndt,h see lectainodon r deroifnd gi fferentials
findifnrgo,mw hicah l isotfd iffereinstb iraolksed no wn foera cgha muwte reb aseudp ona c ombinatiooftn h em ost
inttoh eT op3 ,a lonwgi t"ha dditiodniaalg nocsotincs iderlai­kedliya gnotos beese nrountereidna b oarsde ttiansweg l,l
tionTsh.e" discussescitiooonnfe accha sper ovidae bsr iefa sc linipcraalc tiScoern.e " additiodniaalg nocsotnisci dera­
revioefwi mportiamnatg ianngd c linimcaanli festatifoorn st ionwse"r see lecotveedor t he(rwsh ich amcatyu ableml oyr e
aleln titioenst he loifds itff erentimaalksi,n g at hhiigsh ­rommon)i no rderto provitdheeo pportutnoid tyi scuasss
yielrde ferefonrc beo ard prepalrmaatgiiopnneg.a rls amraen yd iagnoesnttiitci aesps o ssitbhlreo ughtohuebt o ok.
providaettd h ee ndo fe accha steoa llofwo arq uicrke view 1 sinœrehloyp et hayotu fintdh iTso p3 case-based
ofke y poinTthse.fi nadli agnoisspi rso vidfeoder a ccha se;a pproaecnhj oyaabnldue s efualn,d I w isyho ua ltlh eb est
howeveirti, sb yn om eantsh efo cuso ft hirse view bIono ki.nyo urf utuerned eavors.
viii