Neuro radiology central press
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Transcript of Neuro radiology central press
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NeuroradiologyDate 25.02.15
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History
• A 40 year male presented with
• Headache for 2 days 6 days ago.
• Weakness of Rt LL f/b Rt UL since 2 days.
• Dizziness and swaying while walking since 2 days.
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O/E• Pt afebrile : PR 98/min : BP 170/100 rt UL supine position.
• Nervous system• Bilateral papilloedema. Rt side UMN facial palsy.
• Tone –increased in Rt UL&LL. Power 3/5 in UL & 4/5 in LL : brisk knee jerk on right side . plantar bilateral flexors. Sensory examination N.
• Gait ataxia.
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17.02.15
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T 1
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T 2
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Differential diagnosis
• ADEM• PRES• Ischemic stroke.
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21.02.15
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• CSF Glucose, Protein normal 10 Cells 100% lymphocytes.
• 2D ECHO ? Vegetations in AML Hyper echoic mass (2.5ₓ 1.5)in LV.
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Central variant PRES• PRES is a clinico radiologic syndrome that typically involves
Parieto occipital and posterior frontal area with cortical and sub cortical edema.
• In more severe or atypical cases, • Periventricular white matter, • basal ganglia, • brainstem, • anterior frontal and • temporal cortexes can also be involved.
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• Involvement of the basal ganglia or brainstem (central variant) is seen in 10-20% of PRES cases.
• Current theory is - endothelial cell dysfunction occurs within smaller, perforating vessels supplying the brainstem and basal ganglia, possibly related to increased sensitivity in these regions.
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• Imaging features- DWI appeared normal in all patients with central-variant PRES.
• Susceptibility-weighted imaging, which was performed in four of five patients, depicted multiple punctate micro hemorrhages in two patients.
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Case 1- 41 yr male , post lung transplantation ,on immuno suppression.
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• Atypical radiological features of PRES…
1. Contrast enhancement2. Diffusion restriction3. Hemorrhagic PRES
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Contrast enhancement
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Diffusion restriction
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Hemorrhagic PRES
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THANK YOU
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