Trigeminal Neuropathy

Distal pontine dorsolateral infarction may cause ipsi-lateral facial anesthesia, because the lesion damages the entering and descending fibers of the fifth nerve E.g., multiple sclerosis an attack of numbness of one side of the face in a young person, occasionally after local anesthesia for dental work, is quite a common symptom of multiple sclerosis - Congenital, e.g., Chiari malformations - Secondary, e.g., trauma, ischemic necrosis, high cervical intramedullary tumor Meningioma Usually...

Dementia

Dementia is very common, and is the most disabling psychiatric disorder in the adult population. The incidence increases exponentially with age, from 0.5 at age 40 years up to 20 of the population aged 80 years and over. Over 80 of patients with dementia suffer from a small number of conditions, associated with characteristic types of pathology and different etiologies. AIDS acquired immune deficiency syndrome. AIDS acquired immune deficiency syndrome. Frontal predominance atrophy, abnormal...

Femoral Neuropathy

The femoral nerve arises in the lumbar plexus from branches of the posterior division of the L2-4 roots. The nerve passes between and innervates the iliac and psoas muscles. It then descends beneath the inguinal ligament, just lateral to the femoral artery, to enter the femoral triangle in the thigh, where it divides into the anterior and posterior divisions. The nerve may be damaged by penetrating lacerations or missile wounds, complications of femoral angiography, retroperitoneal tumors or...

Herniated intervertebral disk

- Original disk not re- This may occur if a disk fragment is left in the inter-moved vertebral disk space, or if the wrong disk level was removed. Patients will continue to have the preoperative leg pain, due to continued mechanical compression and inflammation of the same nerve root. Patients will wake up from surgery complaining of the same preoperative pain, and will continue without ever being pain free. Patients will benefit from repeat surgery - Recurrent disk at the Patients will develop...

Congenital Posterior Fossa Cysts and Anomalies

In 70 of cases, the syndrome has a number of associated anomalies, such as hydrocephalus, agenesis of the corpus callosum, nuclear dysplasia of the brain stem, and other cerebrocerebellar heterotopias Large posterior fossa and CSF cyst, high transverse sinuses and tentorial insertion, vermian, cerebellar hemispheric and brain stem hypoplasia in 25 of Mild vermian hypoplasia, moderately enlarged fourth ventricle although the posterior fossa is typically of normal size, the brain stem is normal,...

Brain Metastases

A known history of systemic cancer and the presence of multiple lesions on magnetic resonance imaging (MRI) make the diagnosis of metastatic brain tumor probable. Even a typical scan only suggests, but does not prove, that the lesion is a brain metastasis and not another lesion, such as a primary brain tumor or a cerebral abscess. Stereotactic needle biopsy is required for definitive diagnosis. Acoustic neurinoma and pituitary adenoma - Meningiomas show homogeneous contrast enhancement, a...

Scar Versus Residual Disk

Magnetic resonance imaging (MRI) without intravenous contrast is at least as good as contrast computed tomography (CT) in distinguishing scar tissue from disk material, yielding an accuracy of 83 . The addition of gadolinium diethylene-triamine-penta-acetic acid (Gd-DTPA) enhancement further increases the diagnostic accuracy from 89 to 96 . Overall sagittal and axial Tl-weighted pre-Gd-DTPA and post-Gd-DTPA MRI remains the single most effective method of evaluating the postoperative lumbar...

Carpal Tunnel Syndrome

The carpal tunnel syndrome should be considered when there is any unexplained pain or sensory disturbance (e.g., intermittent numbness and acroparesthesia of the hand that is worse at night) and weakness of the abductor pollicis brevis, the lateral two lumbricals, the opponens polli-cis, and the flexor pollicis brevis muscles. Carpal tunnel syndrome occurs as a result of compression of the median nerve beneath the carpal tunnel ligament, and affects 1 of the population. The following physical...

Sciatica

Intervertebral disk dis- In most cases, sciatica is disk related and is caused by ease degenerative changes of the two lower lumbar motion Spinal stenosis In many cases, caused indirectly by a disorder of the Spondylolisthesis Spondylitis Vertebral tumors Extravertebral retroperitoneal tumors Sciatic nerve damage due to injection Is usually bilateral, and is little influenced by position changes and or traction Nerve root irritation is bilateral, and not influenced by motion or traction. Night...

Multiple Sclerosis Like Lesions

Multiple sclerosis MS is a clinical diagnosis that should never be made using neuroimaging alone. In 78-95 of clinically diagnosed MS patients, gadolinium-enhanced magnetic resonance imaging MRI features include ovoid periventricular, infratentorial, temporal lobe, and corpus callosum white matter lesions that are isointense to hypointense on Tl-weighted images, and show high intensity on proton density and T2-weighted images. Many conditions have to be taken into account in the differential...

Sulci

Present transependymal migration of CSF, especially to the frontal and occipital horns. Edema resolves quickly after ventricular decompression by shunting, within 24 hours Accentuated in normoten-sive hydrocephalus Thin, distended, rounded elevation. Increased forni-cocallosal distance Normal except in Alzheimer's disease Normal except in cere-bellar atrophy Normal or atrophied Normal fornicocallosal distance Markedly enlarged in Alzheimer's disease

Meralgia Paresthetica Bernhardt Roth syndrome

The lateral cutaneous nerve is a purely sensory branch arising from the lumbar plexus L2-L3 . It passes obliquely across the iliac muscle, and enters the thigh under the lateral part of the inguinal ligament. It supplies the skin over the anterolateral aspect of the thigh. Meralgia paresthetica is a condition caused by entrapment of this nerve as it passes through the opening between the inguinal ligament and its attachment 1 - 2 cm medial to the anterior superior iliac spine. Numbness is the...

Cerebellopontine angle

The basal nucleus of Meynert, the pallidum, subthalamic nucleus, substantia nigra, locus ceruleus, and superior colliculi patients have ophthalmoparesis of downward gaze, Parkinsonism, pseudobulbar palsy, and frontal lobe signs Paramedian and basal infarction e.g., Millard-Gubler syndrome, Gasperini's syndrome, and Foville's syndrome E.g., gliomas, metastases many of the pontine gliomas start in the region of the sixth and seventh nerve nuclei Progression of the disease is marked by symptoms of...

Syndrome of Inappropriate Secretion of Antidiuretic Hormone and Diabetes Insipidus

The syndrome of inappropriate secretion of antidiuretic hormone SIADH involves the release of antidiuretic hormone ADH at levels inappropriate for a low serum osmolality. Due to continued water ingestion, the elevated ADH results in water retention, hyponatremia, and hypo-osmolality. SIADH results from partial damage to the supraoptic and paraventricular nuclei or neighboring areas, or from production of ADH by tumor or inflammatory tissue outside the hypothalamus. The laboratory criteria for...

Causes of Horners Syndrome

Horner's syndrome is an interruption of the sympathetic supply to the eye, resulting in the classic triad of ptosis, miosis, and anhydrosis. - Amyotrophic lateral sclerosis or Lou Gehrig disease Hypothalamus to upper thoracic cord E.g., hemispherectomy massive infarction may cause The sympathetic and spinothalamic pathways in the brain stem lie throughout their course next to each other. Horner's syndrome here is therefore frequently associated with contralateral pain and temperature loss E.g.,...

Fig 1 Suprasellar lesions neoplastic

Coronal T1 WI with a pituitary macroadenoma in close relationship with the optic chiasm presenting a heterogeneous, post-contrast high intensity signal. 3. Pituitary macroadenoma. Sagittal T1 WI shows a pituitary tumor with a heterogeneous postcontrast high intensity signal with cystic and or necrotic features in its posterior section filling the suprasellar cisterns and exerting compression on the optic chiasm. 4, 5. Craniopharyngioma. A suprasellar...

The differential diagnosis of Lhermittes signs includes

Spinal metastasis Cervical spondylosis Cervical disk herniation Multiple sclerosis Posttraumatic syndrome Subacute combined degeneration Cisplatin chemotherapy Cervical radiation Patients may also present with progressive weakness, sometimes with lower motor neuron signs including fasciculations, in association with sensory loss and autonomic dysfunction such as incontinence and postural hypotension. - CSF analysis typically shows inflammatory changes - MRI usually shows a normal spinal cord on...

Spinal Extradural Cysts

Spontaneous spinal nerve root diverticula and cysts Tarlov cysts Posttraumatic or postoperative meningeal diverticula Spinal ganglion cysts and spinal synovial cysts These cysts arise as an evagination or herniation of the arachnoid that gradually enlarges. Its neck eventually closes, creating a cyst that no longer communicates with the CSF space. The cysts are located exclusively or primarily in the thoracic spine in 86 of cases, and less frequently in the cervical region 2.5 and lumbosacral...

Multiple Lumbar Spine Surgery Failed Back Syndromes

A history of failed lumbar spine surgery represents a diagnostic and therapeutic challenge for the physician. The first step is to distinguish between patients whose back or leg pain originates from a systemic cause e.g., pancreatitis, diabetes, abdominal aneurysm and those with a mechanical problem a thorough medical evaluation should therefore be undertaken in this group at the same time as the neurosurgical evaluation is carried out. Patients with profound emotional disturbances and...

Spinal Intradural Cysts

Intraspinal neurenteric cysts form a spectrum that merges with intraspinal teratomas and intraspinal dermoids and epidermoids. More than 60 of the cases are diagnosed in the first 20 years of life 44 are located totally or partially in the cervical spinal canal, 37 are located in the thoracic spinal canal, and 19 in the lumbosacral spinal canal. The neurological signs and symptoms of a slowly progressing mass are associated by congenital anomalies, such as thickened or pigmented skin, a...

Sources of subarachnoid metastases

- Primary neuroec-todermal tumors PNETs - Glioblastoma multiforme, anaplastic astrocytoma - Chronic meningitis Fungal and granulomatous meningitis. Chronic menin- gitides have a predilection to invade the basal cisterns Coccidioidomycosis imitans meningitis Cryptococcus neoformans meningitis Posttraumatic basal cranial adhesions

Multifocal White Matter Lesions

Hypertension and ischemic white matter lesions leukokraurosis Increases with age, and has also been seen with chronic hypertension. There are two types of ischemic white matter lesions - Lesions involving the watershed distribution of the major brain arteries - Lesions caused by intrinsic disease of the small penetrating medullary arteries arteriolar sclerosis Enlargement of these perivascular spaces with age and hypertension, associated with thinning, pallor and atrophy of the adjacent myelin,...

Corpus Callosum Lesions

Near the top of the list of lesions involving the corpus callosum are There is a propensity for shearing injuries in this location, because of its relatively fixed location spanning the interhemispheric fissure White matter lesions - Multiple sclerosis Severe hydrocephalus, and after ventricular shunting The frequent localization of acute and chronic MS lesions in the corpus callosum is thought to be due to tracking of these lesions along the ependymal veins from the ventricular surface into...

Skull Base

Osteopetrosis Paranasal Sinus

Extracranial lesions - Nasal, paranasal sinus malignant tumors Orbital plates, frontal bones, cribriform plate, planum sphenoidale Occur in up to 30 of anterior skull base cases. Carcinomas represent 98 of adult nasopharyngeal tumors Squamous cell carcinomas 80 , adenocarcinomas 18 Rhabdomyosarcoma the most common soft tissue sarcoma in children up to 35 of these lesions occur here Esthesioneuroblastoma, or olfactory neuroblastoma arises from the bipolar sensory cells and is histologically...

Postoperative Brain Scar Versus Residual Brain Tumor

Extracellular Methemoglobin Mri

There is nothing more frustrating for the neurosurgeon than a postoperative CT scan or MRI showing residual tumor after a supposedly complete resection. Granulation tissue, which enhances on CT and MRI due to its fi-brovascular nature, develops 72 hours after surgery. After that time, it is consequently difficult to distinguish between enhancing surgical bed tissue and marginal residual tumor, assuming that there was preopera-tive tumor enhancement. The scan enhancement may persist for several...

Posterior Fossa Tumors

Posterior Fossa Ependymoma Mri

Differentiation between medulloblastoma, ependymoma, and astrocytoma based on their radiological characteristics Fig. 3 . Hypodense nodule enhances cyst does not 4 th ventricle, superior medullary velum 1. Medulloblastoma. Axial MRI T1 WI shows a solid space-occuping lesion with a moderate signal intensity on T2WI which occupies the area behind the 4th ventricle exerting pressure on it. 2. Ependymoma. Axial MRI T1 WI shows a multilobular space-occuping lesion with solid features, which are...