Osborn's Brain: Imaging, Pathology, and Anatomy

4286 Pages·2012·98.39 MB·English

by  Anne G. Osborn

Osborn's Brain Imaging
Osborn's Brain Imaging
Table of Contents
Osborn's Brain ............................................................................................................................................... 4
Cover ......................................................................................................................................................... 4
Author ....................................................................................................................................................... 4
For Ron ...................................................................................................................................................... 5
Preface ....................................................................................................................................................... 5
Production ................................................................................................................................................. 6
Acknowledgements ................................................................................................................................... 7
Image Contributors ................................................................................................................................... 8
Part One - Trauma ................................................................................................................................... 12
1. Trauma Overview ............................................................................................................................ 12
2. Primary Effects of CNS Trauma ....................................................................................................... 28
3. Secondary Effects and Sequelae of CNS Trauma .......................................................................... 138
Part Two - Nontraumatic Hemorrhage and Vascular Lesions ............................................................... 196
10. Vasculopathy ............................................................................................................................... 196
4. Approach to Nontraumatic Hemorrhage and Vascular Lesions .................................................... 338
5. Spontaneous Parenchymal Hemorrhage ...................................................................................... 357
6. Subarachnoid Hemorrhage and Aneurysms.................................................................................. 416
7. Vascular Malformations ................................................................................................................ 497
8. Arterial Anatomy and Strokes ....................................................................................................... 587
9. Venous Anatomy and Occlusions .................................................................................................. 705
Part Three - Infection, Inflammation, and Demyelinating Diseases ..................................................... 776
11. Approach to Infection, Inflammation, and Demyelination ......................................................... 776
12. Congenital, Acquired Pyogenic, and Acquired Viral Infections ................................................... 783
13. Tuberculosis, Fungal, Parasitic, and Other Infections ................................................................. 889
14. HIV-AIDS ...................................................................................................................................... 982
15. Demyelinating and Inflammatory Diseases ............................................................................... 1057
Part Four - Neoplasms, Cysts, and Tumor-like Lesions ....................................................................... 1147
16. Introduction to Neoplasms, Cysts, and Tumor-like Lesions ...................................................... 1147
17. Astrocytomas ............................................................................................................................. 1169
18. Nonastrocytic Glial Neoplasms .................................................................................................. 1277
19. Neuronal and Glioneuronal Tumors .......................................................................................... 1348
20. Pineal and Germ Cell Tumors .................................................................................................... 1395
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21. Embryonal and Neuroblastic Tumors ........................................................................................ 1452
22. Tumors of the Meninges ........................................................................................................... 1507
23. Cranial Nerves and Nerve Sheath Tumors ................................................................................ 1588
24. Lymphomas, Hematopoietic and Histiocytic Tumors ................................................................ 1682
25. Sellar Neoplasms and Tumor-like Lesions ................................................................................. 1773
26. Miscellaneous Tumors and Tumor-like Conditions ................................................................... 1893
27. Metastases and Paraneoplastic Syndromes .............................................................................. 1946
28. Nonneoplastic Cysts .................................................................................................................. 2012
Part Five - Toxic, Metabolic, Degenerative, and CSF Disorders .......................................................... 2116
29. Approach to Toxic, Metabolic, Degenerative, and CSF Disorders ............................................. 2116
30. Toxic Encephalopathy ................................................................................................................ 2162
31. Inherited Metabolic Disorders .................................................................................................. 2239
32. Acquired Metabolic and Systemic Disorders ............................................................................. 2375
33. Dementias and Brain Degenerations......................................................................................... 2505
34. Hydrocephalus and CSF Disorders ............................................................................................. 2627
Part Six - Congenital Malformations of the Skull and Brain ................................................................ 2733
35. Embryology and Approach to Congenital Malformations ......................................................... 2733
36. Posterior Fossa Malformations ................................................................................................. 2759
37. Commissural and Cortical Maldevelopment ............................................................................. 2827
38. Holoprosencephalies, Related Disorders, and Mimics .............................................................. 2912
39. Neurocutaneous Syndromes ..................................................................................................... 2951
40. Vascular Phakomatoses ............................................................................................................. 3066
41. Anomalies of the Skull and Meninges ....................................................................................... 3107
Abbreviations .................................................................................................................................. 3162
Index .................................................................................................................................................... 3229
Numbers .......................................................................................................................................... 3229
A....................................................................................................................................................... 3229
B ....................................................................................................................................................... 3293
C ....................................................................................................................................................... 3310
D ...................................................................................................................................................... 3517
E ....................................................................................................................................................... 3558
F ....................................................................................................................................................... 3608
G ...................................................................................................................................................... 3625
H ...................................................................................................................................................... 3665
I ........................................................................................................................................................ 3743
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J ........................................................................................................................................................ 3768
K ....................................................................................................................................................... 3769
L ....................................................................................................................................................... 3771
M ..................................................................................................................................................... 3819
N ...................................................................................................................................................... 3922
O ...................................................................................................................................................... 3975
P ....................................................................................................................................................... 3990
Q ...................................................................................................................................................... 4066
R ....................................................................................................................................................... 4066
S ....................................................................................................................................................... 4074
T ....................................................................................................................................................... 4159
U ...................................................................................................................................................... 4228
V ....................................................................................................................................................... 4229
W ..................................................................................................................................................... 4269
X ....................................................................................................................................................... 4280
Y ....................................................................................................................................................... 4283
Z ....................................................................................................................................................... 4284
Addenda .................................................................................................................................................. 4284
500 Internal Server Error ..................................................................................................................... 4284
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Osborn's Brain Imaging
Osborn's Brain
Cover

Author
Anne G. Osborn MD, FACR
University Distinguished Professor
Professor of Radiology

William H. and Patricia W. Child
Presidential Endowed Chair in Radiology

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Osborn's Brain Imaging
University of Utah School of Medicine
Salt Lake City, Utah
For Ron
Beloved sweetheart and eternal companion, you didn't live to see the book completed. Nevertheless, your
unconditional love and supportive spirit sustained me throughout the process—from beginning to the very end. I
hope it makes you proud! Until we meet again, all my love and devotion right back at you!
Preface
With the publication of Osborn's Brain, I'm breaking a longstanding promise to myself: I swore I'd never, EVER, write
another prose-based book. And yet here it is. But let me tell you, this isn't just “another prose book.” Far from it!
When my colleagues and I published the first edition of Diagnostic Imaging: Brain, Dr. Michael Huckman said in his
Foreword to the book, “[Osborn] has decided to abandon the usual conventions of medical textbooks.” Amirsys's
now-classic bulleted format does indeed deliver more information in less space than traditional prose. And I do
love those efficiencies! However, I want to give more than, “Just the facts, ma'am.” I want to show the thinking
behind the facts. The reasoning. The framework that facilitates understanding a tough, complex subject.
That's why I've structured the book as a learning curriculum. We start with the most immediate “must know”
topics, beginning with trauma. We next discuss nontraumatic hemorrhage, stroke, and vascular lesions. In other
words, we jump right into emergent imaging issues before delving into infections, demyelinating and inflammatory
diseases, neoplasms, toxic-metabolic-degenerative disorders, and congenital brain malformations.
If you're just starting your residency in radiology, neurosurgery, or neurology, I suggest you begin at the beginning.
Read the first three chapters and digest them. Then go part by part, chapter by chapter, straight through the book.
If you are a senior resident or fellow, this is a great way to review what you think you already know pretty well. I
guarantee you, there's stuff in here that will be new to you. If you're a practicing general radiologist,
neuroradiologist, or neurosurgeon, consider this a neuroimaging refresher course. And if you are an honest-to-
goodness neuroradiologist, I've tucked a number of cool tidbits into every chapter that I hope you will find
intriguing and thought-provoking.
Many of you have asked, emailed, and even written (yes, old-fashioned written) me with your pleas for a new
“Osborn.” So here it is. I wrote every word of it myself, so the style is mine alone and the approach is therefore
consistent from chapter to chapter. I've combined essential anatomy together with gross pathology and imaging to
show you just why diseases appear the way they do. The book is illustration-rich, with loads of high definition
state-of-the-art imaging and glorious color. My trademark summary boxes are scattered throughout the text,
allowing for quick review of the essential facts.
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I've drawn on an entire career of accumulated knowledge and intense interest in neuropathology, neurosurgery,
and clinical neurosciences to select the very most relevant information for you. It's been fun to do this, the
culmination of my decades of continued learning in our beloved subspecialty. I hope you enjoy the journey!
Best regards and good reading!
Anne G. Osborn, MD, FACR
University Distinguished Professor
Professor of Radiology
William H. and Patricia W. Child Presidential Endowed Chair in Radiology
University of Utah School of Medicine
Salt Lake City, Utah
Production
Editor in Chief
Ashley R. Renlund, MA
Text Editing
Kellie J. Heap, BA
Dave L. Chance, MA
Arthur G. Gelsinger, MA
Lorna Kennington, MS
Rebecca L. Hutchinson, BA
Angela M. Green, BA
Kalina K. Lowery, MS
Image Editing
Jeffrey J. Marmorstone, BS
Lisa A. M. Steadman, BS
Medical Editing
Pieter Janse van Rensburg, MB, ChB, FRCR
Donald V. La Barge, MD
Karen L. Salzman, MD
Brian Chin, MD
Paula J. Woodward, MD
Kevin R. Moore, MD
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Illustrations
Lane R. Bennion, MS
Richard Coombs, MS
Laura C. Sesto, MA
James A. Cooper, MD
Art Direction and Design
Laura C. Sesto, MA
Software Development
R. J. Sargent, BS
Publishing Lead
Katherine L. Riser, MA
Acknowledgements
No one truly ever produces a text of this magnitude alone. While I am the sole author, there are many individuals
who have contributed everything from images to suggestions, opinions, and ideas. Thank you from the bottom of
my heart. You know who you are.
Several individuals and groups deserve special mention. First of all, thanks to our neuroradiology colleagues at the
University of Utah for their support. A big one to Brian Chin, my 2011-12 clinical neuroradiology research fellow
who tirelessly searched out cases and references for the book. Couldn't have done it without you!
Ever since my sabbatical as Distinguished Scientist at the world-renowned Armed Forces Institute of Pathology in
Washington, D.C. (which alas is no more, a victim of government downsizing), pathology has formed the foundation
of how I view and teach neuroradiology. It's a big part of this text. Special thanks to Richard H. Hewlett and his
colleague, the late Stuart Rutherfoord, whose elegant gross photographs make the book sing. Thanks also to Peter
Burger, the late Bernd Scheithauer, and their wonderful neuropathology colleagues. Some of the images
reproduced here come from their wonderful synoptic text, Diagnostic Pathology: Neuropathology (Amirsys
Publishing, 2012).
Thanks to the entire Amirsys team. Special mention and profound thanks goes to our inimitable, indomitable, and
beloved colleague Paula Woodward, MD. Paula stepped into the editing and production wherever needed. At the
end, she jumped in to do a bunch of heavy lifting with the medical edits to keep us on a very tight, unforgiving
schedule. Ashley Renlund, our chief editor, made invaluable suggestions, polishing the text and layout. She worked
tirelessly to fit almost all the images on the same or facing pages with the referenced text.
Thanks to the international Amirsys Brain, Spine, and Head and Neck case teams. You guys have contributed
amazing stuff over the years to the Amirsys database, which now reaches tens of thousands of radiologists and
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trainees through STATdx™ and RadPrimer™. You have enhanced teaching and improved patient care around the
world. Thanks for your superb work…and prompt response when any of us emailed an urgent “request for cases” for
one of our many projects. It didn't matter how common or obscure the diagnosis, someone somewhere (and often
several of you) sent a perfect case.
Thanks also to the many colleagues who have generously given me fascinating cases over the years. I've tried to
keep track of which case came from whom and to acknowledge you appropriately in the captions. Special thanks to
all of the image contributors.
Anne G. Osborn
Image Contributors
AFIP Archives
S. Galetta, MD
S. Lincoff, MD
R. Ramakantan, MD
N. Agarwal, MD
L. Ginsberg, MD
L. Loevner, MD
C. Robson, MBChB
B. Alvord, MD
C. Glastonbury, MD
S. Ludwin, MD
F. J. Rodriguez, MD
S. Andronikou, MD
S. Harder, MD
T. Markel, MD
P. Rodriguez, MD
J. Ardyn, MD
H. R. Harnsberger, MD
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Osborn's Brain Imaging
M. Martin, MD
A. Rosenberg, MD
M. Ayadi, MD
B. Hart, MD
V. Mathews, MD
E. Ross, MD
S. Aydin, MD
M. Hartel, MD
A. Maydell, MD
A. Rossi, MD
C. Baccin, MD
E. T. Hedley-Whyte, MD
S. McNally, MD
L. Rourke, MD
R. Bert, MD
G. Hedlund, DO
T. Mentzel, MD
E. Rushing, MD
S. Blaser, MD
S. Hetal, MD
M. Michel, MD
M. Sage, MD
J. Boxerman, MD
R. Hewlett, MD
K. Moore, MD
B. Scheithauer, MD
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