By Anne G. Osborn, Jeff Ross, Julia Crim, Karen L. Salzman, Susan I. Blaser, Bryson D. Borg, Bronwyn E. Hamilton, Gregory L. Katzman, Gary M. Nesbit, James D. Eastwood
A part of the EXPERTddx sequence, this targeted print-and-electronic reference will consultant radiologists towards logical, on-target differential diagnoses in response to key imaging findings and scientific details. The booklet offers the main priceless differential diagnoses for every sector of the mind and backbone, grouped in response to particular anatomic situation, favourite imaging findings, modality-specific findings, or clinically-based indication. every one differential prognosis comprises no less than 8 transparent, sharp, succinctly annotated photos; a listing of diagnostic chances taken care of as universal, much less universal, and infrequent yet vital; and short, bulleted textual content delivering beneficial diagnostic clues.The spouse on-line Amirsys ebook virtue offers extra annotated photos.
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Extra resources for Expertddx: Brain and spine
Use contrast! • Glutaric aciduria type 1 = child abuse mimic I 1 32 Helpful Clues for Common Diagnoses • Benign Familial Macrocrania o Family history important • Intraventricular Hemorrhage o Hemosiderin not always apparent on follow-up images • Aqueductal Stenosis o Look for associated hemosiderin, vascular anomalies • Arachnoid Cyst o Steady-state acquisition sequence to identify cyst wall • Enlarged Subarachnoid Spaces o Look for traversing veins o Natural history: Resolution by 12-18 months • Villous Hypertrophy of the Choroid Plexus o Likely on a spectrum, including choroid plexus papilloma o Bilateral choroid plexus lesions typical • Subdural Hematoma, Chronic o MR identifies hemorrhagic components Helpful Clues for Less Common Diagnoses • Dandy-Walker Continuum o Classic Dandy-Walker & Blake pouch cyst: Vermian angulation, large bony posterior fossa o Classic Dandy-Walker • Incompletely lobulated vermis, deficient fastigial recess/primary fissure o Blake pouch cyst • Intact vermis, fastigial recess, and primary fissure • Neoplasm o Large, bulky neonatal tumors o Glioblastoma Multiforme • Enhancement, necrosis, hemorrhage o Teratoma • Fat, calcium, enhancing soft tissue • Neurofibromatosis Type 1 o Look for foci of abnormal signal intensity (FASI), optic nerve gliomas, cafe-au-lait spots o Macrocrania predominantly derived from bulky white matter • Tuberous Sclerosis Complex o Cutaneous markers (ash-leaf spots) may be occult in 1st year of life o Look for Ca++ subependymal nodules, radial Iines • Hemimegalencephaly o Look for cutaneous markers & stigmata of overgrowth syndromes • Hypomelanosis of Ito • Proteus syndrome • Linear sebaceous nevus syndrome en ;J; MACROCEPHALY c: • Megalencephaly Syndromes o Clues in name • Megalencephaly, polymicrogyria syndrome • Megalencephaly with dilated Virchow-Robin spaces • Cerebral gigantism (Soto syndrome) • Macrocrania-cutis marmorata telangiectatica congenita Helpful Clues for Rare Diagnoses • Hydranencephaly o Distinguish from maximal hydrocephalus o MR shows cortex, falx • Glutaric Aciduria Type 1 o Bilateral temporal lobe hypoplasia & large sylvian fissures o Resembles bilateral middle cranial fossa arachnoid cysts o Crisis: Caudate, putamen, globus paIlidus swelling, & t signal • MLCI o Diffusely t white matter signal o Temporal pole & frontoparietal cysts o Macrocrania differentiates from CMV (common microcephaly) • Mucopolysaccharidosis o Dilated perivascular spaces • Alexander Disease o Enhancement is the key to diagnosis!
DIFFERENTIAL DIAGNOSIS (j) c: III •.... al "t:l c: III :J -'C/)" Common • Skull Normal Variants o Parietal Thinning o Squamous Temporal, Occipital Bones • Arachnoid Cyst • Mega Cisterna Magna Less Common • Slow Growing Neoplasm o Oligodendroglioma o D ET o Ganglioglioma o Diffuse Astrocytoma, Low Grade • Paget Disease • Scalp Lesions o Dermoid Cyst o Epidermoid Cyst o Neurofibroma Rare but Important • Meningioma • Linear Scleroderma (Coup de Sabre) ESSENTIAL INFORMATION Key Differential Diagnosis Issues • Evaluate underlying brain, overlying scalp!
Note temporal lobe ~ frontoparietal cysts E±l near vertex. Large head =- circumference I 1 36 this from CMV distinguishes Aciduria Type 1 Tuberous Sclerosis Complex MACROCEPHALY Dl ::::s C- O) Mucopolysaccharidosis ~ Dl Alexander Disease (Left) Sagillal T7WI MR shows dilated perivascular spaces 1:12. Callosal and perilrigonal distribution is the most common. (Right) Axial T2WI MR shows a frontal predominance of white maller signal ::::s [f) (") OJ -0 increase. Additionally, the caudate heads ~ and putamina ~ are bright Alexander Disease Canavan Disease (Left) Coronal T7 C+ MR shows enhancement of = teardrop-shaped fomiceal columns Sl chiasm and periventricufar while matter 1:12.