
By Kendra Stanton
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Cryptococcosis (atypical) (28E, axial FLAIR). Lymphoma (28D) shows strong enhancement and might be difficult to distinguish from TB. Involvement of the basal ganglia, periventricular WM, and ependymal surfaces would favour lymphoma. Toxoplasmosis would present as an enhancing lesion that would be expected to respond to anti-microbial therapy. The typical appearance of an abscess is a rim-enhancing, T2 hyperintense structure with centrally restricted diffusion. Image 28E shows multiple hyperintense lesions affecting the deep grey nuclei bilaterally, the splenium of the corpus callosum, and the WM surrounding the occipital horn of the right lateral ventricle.
Treatment is surgical resection with cranio-spinal radiation and chemotherapy. Detection of a pineal region mass mandates complete screening of the spine for drop metastasis. TEACHING PEARLS ➣ Pineal mass in men: 80% is germinoma. ➣ Pineal mass in women: 50% is pineal cell tumour (pineocytoma or pineoblastoma), 50% germinoma (See Question 38). ➣ Heterogenous pineal mass is often associated with necrosis, haemorrhage, and peripherally displaced calcification. ➣ Poor prognosis is due to cerebrospinal fluid dissemination.
I. What type of MRI sequence is demonstrated (14A, B)? ii. What structure is abnormal in the images above? 15A 15B 15C 15 A 40-year-old male patient presents with pain and numbness in the middle finger of his right hand. i. What does the sagittal T2 STIR image (15A, B) show? ii. What effects are seen on the axial T2-weighted image (15C)? iii. What nerve is likely compressed? 33 14, 15: Answers 14 DIAGNOSIS Rhomboencephalosynapsis. IMAGING FINDINGS Two axial T1-weighted images are presented for evaluation (notice bright subcutaneous fat and dark CSF) (i).
500 Eye Makeup Design by Kendra Stanton
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