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e-Radiology Learning | Neuroradiology Pearls and Pitfalls (1 of 4)

e-Radiology Learning | Neuroradiology Pearls and Pitfalls (1 of 4)


[MUSIC] [MUSIC] Hi, it’s Dave Yousem from the neuroradiology division, of Johns Hopkins
Hospital. I’d like to share with you one of our neuroradiology pearls and pitfalls
presentations. This first case is a 37 year old woman,
who presented three months after bariatric surgery, with confusion, ataxia, and
ophthalmoplegia. What you’re seeing is three images from
the patient’s flare scan, in which there is bright signal intensity
on the flare scan, in the periaqueductal gray matter As well
as in the posterior midbrain, as well as in the medial thalami
bilaterally and fairly symmetrically. If you look on the diffusion-weighted scan
to your bottom right, it’s very bright on the
diffusion-weighted scan. In some cases with this entity, the patient has enhancement also of the
abnormality. So what would be the ideology for this? The correct diagnosis in this case is
thiamine deficiency. This is a bilateral symmetrical process, which typically affects the periaqueductal
gray matter, the mammillary bodies, the
forniceal regions, as well as the medial thalami. You may see restricted diffusion, and you
may see contrast enhancement. The importance about making this specific
diagnosis is that if it is caught early, the patient’s
symptoms are reversible. However, if there’s a delay in diagnosis, the patient’s symptoms may become
irreversible and they may develop an encephalopathy know as Wernicke Korsakoff psychosis, which is a
devastating abnormality. Now, patients who have had bariatric
surgery where portions of their stomach have been resected, may have
the absence of absorption of thiamine secondary to their
surgery or due to their nutritional changes after the
surgery leading to thiamine deficiency. The differential diagnosis here is
relatively limited. You can have artery of pressure on basilar
artery thrombosis leading to a stroke or the differential diagnosis might
include a venous infarction, or less likely, a
tumor. So this is a diagnosis that should be made
and is an important one with respect to the
reversibility of the symptoms. If you’d like to see additional
presentations of this type on the neuroradiology pros
and pitfalls, please see our Johns Hopkins
Facebook pages, which include the E-radiology
Learning Facebook page. Or specific to neuroradiology is our John Hopkins Neuroradiology Divisional
Facebook page. Thank you very much. I hope I see you on the internet.

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