What The Font?

Are people really upset about this? So IKEA changes fonts from "Futura" to "Verdana".... It's all people are talking about on the internet. So what if it's a Microsoft font? I don't see the difference....

A week ago, Romanian design consultant Marius Ursache started an online petition called "Ikea, Please Get Rid of Verdana." As I write this, the petition has almost 3,000 signatures.

Oh, wait a minute.... After seeing the difference between the two fonts.... Oh, no, wait.... I still don't care.

Double Down

KFC has a nine and a two, the dealer has a four showing..... What do they do? Double Down!

Sorry. I didn't laugh either.... Anyway, Kentucky Fried Chicken is testing their new Double Down Sandwich in Omaha, Nebraska and Providence, Rhode Island. The new sandwich consists of two slices of bacon, a slice of pepper jack cheese, a slice of Swiss cheese, and some of the Colonel's sauce, all between two filets of KFC original recipe chicken.

Sorry cholesterol, I want one. Maybe I'll order it without the "Colonel's Sauce".

Radiology teaching files for iPhone

Readers who have an iPhone or iTouch, might like to know that the first Radiopaedia Radiology Teaching File is now available for download (free) from the itunes app store. 50 CNS cases comprising 170 images, questions and detailed text. Just search for radiology and you should find it easily enough.

What You Talkin' 'Bout, Willis?

Did you know that the tallest building in the United States, the Sears Tower, has changed names and is now the Willis Tower? It's actually been named the Willis Tower since July....

Have you heard about these new glass-bottomed skydecks they installed at the 103rd Floor! 1,353 feet above the ground! Each deck can hold up to five tons and are now open to the public. Time for a vacation....

Granulomatous hypophysitis

Findings

Figure 1 (unenhanced CT): Well-circumscribed, noncalcified, hyperdense mass in the suprasellar cystern (arrow).
Figure 2 (MRI T1 w/o contrast): Sellar/suprasellar mass, isointense to white matter, with mass effect on the undersurface of the optic chiasm, without hydrocephalus.
Figure 3 (Coronal T1 w/contrast): Mass demonstrates homogenous enhancement.
Figure 4 (Sagittal T1 w/contrast): Extension of mass along a thickened pituitary stalk into the hypothalamus.


Diagnosis: Granulomatous hypophysitis


Granulomatous hypophysitis is a rare inflammatory process, accounting for approximately 1% of pituitary lesions. This entity may be mistaken for a pituitary neoplasm, such as an adenoma. Unlike lymphocytic hypophysitis, which predominantly affects females, young women in late pregnancy or postpartum period, granulomatous hypophysitis appears to have no gender predilection and average age at diagnosis is greater than 40 years.

Patients often present with a headache. Other symptoms may include hypopituitarism, diabetes insipidus, hyperprolactinemia, or symptoms associated with chiasmal compression. While preoperative diagnosis is desirable, diagnosis is most often made postoperatively. Granulomatous hypophysitis may be idiopathic or associated with systemic granulomatous disease, such as tuberculosis, syphilis, sarcoidosis, Crohn’s disease or Wegener’s granulomatosis. It also may be associated with foreign body reactions, such as a ruptured Rathke’s cleft cyst or mucocoele.

Imaging characteristics demonstrate a sellar mass with a tongue-like suprasellar extension. The lesion may contact or infiltrate the basal hypothalamus. Pituitary stalk thickening is often a prominent feature. The lesion usually shows marked, homogenous enhancement, although heterogeneous and ring-like enhancement also occur.

Subarachnoid hemorrhage secondary to rupture of left superior cerebellar artery aneurysm

Findings

Initial head CT without contrast: Subarachnoid hemorrhage seen filling the quadrigeminal cistern, suprasellar cistern, and surrounding sulci. This is most prominent in the posterior fossa. There is associated intraventricular hemorrhage and moderate obstructive hydrocephalus. CT head angiography: There is a 3mm L superior cerebellar artery aneurysm


Diagnosis: Subarachnoid hemorrhage secondary to rupture of left superior cerebellar artery aneurysm.


The most common presenting symptom of SAH is "the worst headache of my life." The peak incidence is around 40-60 years of age and is slightly more common in females. Subarachnoid hemorrhage localized to the posterior fossa is uncommon in the setting of trauma and suggests posterior circulation aneurysmal rupture. Hemorrhage is most extensive at the site of aneurysm. Most common sites of aneurysm are in order of decreasing frequency: Anterior communicating artery, posterior communicating artery, middle cerebral artery, anterior cerebral artery, basilar artery, internal carotid artery, PICA, vertebral artery, and superior cerebellar artery. Saccular, berry, or congenital aneurysms constitute 90% of all cerebral aneurysms and are located at the major branch points of large arteries. Infectious or mycotic aneurysms are situated peripherally and comprise 0.5% of all cerebral aneurysms. Amyloid angiopathy typically produces more peripheral areas of hemorrhage.


Staging, grading or classification criteria

Grading:
- Grade 1: Thin SAH = 5 mm
- Grade 2: Thick SAH > 5 mm
- Grade 3: Thin SAH with mass lesion(s)
- Grade 4: Thick SAH with mass lesion(s)

Lower grades have better admission Glasgow coma scores & discharge Glasgow outcome scale scores.


Clinical Course

50% mortality, 15% rebleed within first 24 hr
Natural history: Breakdown & resorption from CSF
Complications: Acute hydrocephalus, delayed hydrocephalus, vasospasm

Acute hydrocephalus
- Rare; usually obstruction of aqueduct or 4th ventricular outlet by clotted SAH
bstructive, non-communicating hydrocephalus
- Asymmetric ventricular dilatation

Delayed hydrocephalus
- Arachnoid granulation defect in CSF resorption
- Obstructive communicating hydrocephalus
+ Symmetric ventricular dilatation

Vasospasm
- May develop quickly (2-3 days post-injury)
- Peaks 7-10 days post-injury, threat remains up to 2 weeks
- Uncommon cause of post-traumatic infarct


Radiologic overview

Best diagnostic clue: Hyperdense CSF on non-contrast CT
Suprasellar, basal, Sylvian & interhemispheric cisterns most common location
Hemorrhage most extensive at site of aneurysm
CT without contrast: 95% positive in first 24 hr, < 50% by 1 week
CTA 90-95% positive if aneurysm = 2 mm
FLAIR: Hyper intense; FLAIR more sensitive than CT but less specific
MRA: 85-95% sensitive: Insufficient detail for surgery
Difficult to see on T1WI, T2WI & GRE
T1WI: CSF mildly hyper intense ("dirty")
Angiography: Negative in 15% of aSAH; repeat positive < 5%

Microsoft Is Racist

First Vista, now this? A Microsoft advertisement was altered to include the head of a white man over the head of a black man for their polish site. Hey Microsoft, if you're going to poorly photoshop a white man's head on a black man's body, the least you can do is poorly photoshop a white man's hands on a black man's body....

Do polish people dislike black people? I'm not quite sure I understand why they changed this photo....

Youth In Revolt

Michael Cera is always good when he's on the screen, but he's always injected a 'George-Michael Bluth' energy into every role. He seems to be pushing the envelope a bit and showing a little pep in this awkward teenager Fight Club-type movie 'Youth In Revolt'.... Check out this trailer....

The Deadly Cables of Barangay Tatalon

Electricity--or rather, its lack--is a big problem among the many residents of Barangay Tatalon, Quezon City. Most of the residents are poor and could not afford the convenience of electricity. Many of them therefore resorted to illegal electric connections. They connected "jumper" wires to the legal connections and stole electricity. Those with legal connections are very angry about this practice, as they assume, and rightly so, that the stolen electricity was being charged to their account. They reported the rampant illegal connections to the Manila Electric Company (Meralco).

The Meralco, with the aid of some policemen, raided Barangay Tatalon. In the jungle of wires and cables, it was almost impossible to find which wires are legal and which are illegal. After a day's work laboriously cutting the illegal connections, the Meralco grouped the legal wires together and fastened them in strings. This way the illegal connections would be easily spotted as they would not be inside the strings that had been installed. The Meralco hoped that this will mitigate illegal connections.

Quite clever, indeed, but not without its problems. As it happened, by stringing the wires together, the Meralco created a volatile situation. Each of the wires can overload (short circuit), and every wire can be affected like a chain reaction, starting with a spark and an explosion--and then fire. The fire trucks will have a hard time entering the fire zone because of the very narrow alleys within the Barangay.

The stringing also affected the height of the wires and cables. Due to its combined weight, the wires now dangle dangerously low and within reach of children playing in the streets. Wires that had been accidentally peeled can electrocute to death any human being. This is one of the accidents just waiting to happen. But so far, no one had been electrocuted...yet.

Barangay Tatalon has already had a history of frequent fires because of this problematic cable and wires situation. In 2006, for example, some 100 houses were burned due to the rampant illegal connections within the barangay. And just recently, last December, 2009, another huge fire hit the barangay with hundreds of families losing their homes.

Children can easily reach out to the electric wires above, hanging dangerously low.



The barangay captain complained that his house no longer looks nice and beautiful

Water pipes and electric wires strung together in this darkened alley

Babies Are Expensive!

We were in Babies'R'Us this weekend, looking for some more cute girl stuff, and we realized that having a baby these days is an expensive proposition.... And it was on clearance!

Winkers - Best Pants Ever!!!!

Has your mother ever said to you, 'You better be good, because I have eyes on the back of my ass.'?

I would buy every pair of these pants, just because of my love for all things bad.... Ok, so maybe they shouldn't have started the commercial with the first pair of pants, they aren't the best example of the Winkers. But, around the 1:04 mark in the video, magic happens. See the mesmerizing quacking duck pants.... Let them draw you in.... Then at the 2:18 mark in the video, the mystical owl draws beckons to you with his wise and playful winks....

I couldn't decide whether I wanted to write that thing about mothers at the beginning of the blog, or if I should write "Hey, is that asshole winking at me?". I'm still torn between the two....

Giant Arachnoid granulation

In the differential diagnosis of masses within the dural sinus it is important to consider dural sinus thrombosis which is potentially dangerous and needs immediate management. Thrombosis usually involves an entire segment of a sinus or multiple sinuses and can extend to cortical veins, whereas arachnoid granulations produce focal, well-defined nodular defects in the sinuses. The key features of giant arachnoid granulations are non-enhancing granules with central linear enhancement and surrounding enhancing flowing blood on contrast-enhanced MR . Refered for second opinion- Teleradiology Providers

Ecchordosis Physaliphora-MRI & CT

Ecchordosis physaliphora is a rare congenital, benign, hamartomatous, retroclival mass derived from notochordal tissue that is typically located intradurally in the prepontine cistern. Ecchordosis physaliphora is usually asymptomatic. In rare cases, ecchordosis physaliphora can be symptomatic due to tumor expansion and compression of the surrounding structures and
extratumoral hemorrhage. Only one previous case of such a lesion with associated bleed is described in Turkish Neurosurgery 2009, Vol: 19, No: 3, 293-296. The differential diagnosis of EP also includes chordoma, dermoid, epidermoid, arachnoid cysts and partially thrombosed vertebrobasilar aneurysm. When a retroclival mass is established on MRI, any associated osseous stalk should be evaluated on thin-section CT as in our case which is classical for the diagnosis of Ecchordosis Physaliphora. This is 30 year old female with T1 and T2 hyperintense lesion in prepontine and retroclival region on MRI with no significant enhancement
Reported by Teleradiology Providers

Back With A Bang #2

I asked for it.... I said "What's next NFL?". Well, they gave it to me... The notably loud All Pro NFL Wide Receiver Chad Ochocinco, who legally changed his name from Chad Johnson to reflect the 85 on his jersey, filled in for the injured kicker in a preseason game between the Cincinnati Bengals and the New England Patriots.

Ochocinco successfully kicked the extra point after the Bengals only touchdown of the the game and kicked off to start the third quarter.... Anything else NFL?

How Much Would You Pay To Be On Top Of Marilyn Monroe?

Do you want to die in style?

Look no further.... Ms. Elsie Poncher of Beverly Hills is selling the crypt space directly above Ms. Marilyn Monroe at Westwood Village Memorial Park. In a plan to help pay her mortgage, Ms. Poncher says she will move her husband's remains over one spot into a crypt intended as her final resting place, and she would be cremated instead when her time comes.

The other well known celebrities sharing their eternal resting place right with Marilyn include: Dean Martin, Farrah Fawcett, Natalie Wood, Peggy Lee, Donna Reed, Mel Torme, Roy Orbison, Burt Lancaster, Jack Lemmon, Walter Matthau, Don Knotts, Frank Zappa, Rodney Dangerfield, Robert Stack, Merv Griffin and Carl Wilson. Hugh Hefner has even purchased the empty crypt space next to Marilyn Monroe.

When she posted the crypt space for sale on Ebay, Ms. Poncher expected to make around $500,000. The bids are now up to $4,602,300.00!!!! How much would you pay to be on top of Marilyn Monroe?

Catch It, Bin It, Kill It

David McCusker is the gentleman who is seen sneezing in this advertisement from the National Health Service in the United Kingdom. The ads were created to help citizens of the United Kingdom combat the evil swine flu.

Well, with a huge slap from irony's open palm, David McCusker has caught the swine flu. He told the London Daily Mail: 'I was supposed to 'Catch It, Bin It, Kill It'. But instead I've been shivering, shaking and spreading it.'

Leaning Tower Of Fail

This video takes me back to the old days.... I remember when I was younger, and I'd build these really awesome towers out of building blocks. There was one, it was beautiful, almost ten blocks high.... Then some kid would walk over and kick it down, and then laugh maniacally.... I ran to my room, tears pouring out of my eyes, screaming "You're such a bully! You're such a bully!". Then my wife would come to console me and tell me, "Your son is only three, he didn't know how hard you worked on that tower."

P.S. Yeah, I know it's fake.... Who needs to answer their phone during a live newscast? Regardless, that sure was a lot of Jenga blocks.

Paraspinal Tuberculosis-MRI

Note the collection in the left paraspinal region with involvement of the facet joint, with extension via the neural canal into the epidural space.

A Lost Father and Daughter

Mang Lupe Mariano, 41 years old, and his little daughter Nina, 7 years old, wanted to go back to their hometown in Compostela Valley, Davao del Norte but they couldn't because they lacked the money to pay for their fare. So Mang Lupe decided to try luck begging for some help from the pedestrians in the Quiapo Underpass. A few coins every now and then were dropped by the passersby, but it seemed that there were very few kindhearted souls who will help the father and daughter get home.

Theirs was an unfortunate story. Father and daughter went to Manila on the invitation of a Manila relative who told Mang Lupe that a good job was waiting for him in Manila. Mang Lupe was very poor but he and his wife managed to borrow some money from friends and relatives for his fare to Manila. He had been working as a farmer in Davao, but his earnings of 80 pesos a day was too little to support his family (wife, and two sons and two daughters). So the job in Manila with a minimum wage--350 pesos a day--looked lucrative. The relative promised that he will be employed regularly.

And so with a 1,500 pesos borrowed money, and his eyes set on a bright future, Mang Lupe boarded a bus to Manila. He brought with him his youngest daughter Nina since their Manila relative promised that there will be a maid who will look after the daughter when Mang Lupe was working. The plan was to bring the whole family later in Manila when the going gets smoother.

Upon his arrival in Manila, Mang Lupe got lost. He couldn't find the address given to him by his relative. Fortunately, he wrote down the cellphone number of his relative. But he didn't have a cellphone, didn't even know how to use one. So he went to a police station to have the police contact the number. As it happened, the cellphone was either "unattended" or "couldn't be reached". The police traced the address. But the address was either wrong or non-existent.

The police thought that maybe Mang Lupe was just acting--that he was only after money. They gave the daughter some food and told Mang Lupe to search further. Meanwhile Mang Lupe was very upset. He couldn't believe that they got lost. When night fell, he and daughter decided to sleep in one of the sidewalks of Quiapo--sharing a space with some of the city beggars. The remaining 20 pesos that was left of their 1,500, was used to buy bread. They drank water from the faucet in the Quiapo public toilet. Now, they were penniless, and Mang Lupe was worried what will happen in the morrow.

The next morning (Friday), they decided to beg for some money so that they can have money for breakfast and eventually, a fare back to Davao. It was a Friday afternoon and I just attended the afternoon mass at the Quiapo Church. As was my custom, I passed through the underpass to go to Quezon Boulevard. It was then that I first noticed Mang Lupe and his daughter --squatting on the steps of the Quiapo Underpass. They didn't look like paupers to me, but the sight of a cute little child begging for some money was enough to remove my doubts.

I asked the little girl her name but she was shy and wouldn't say a word. Mang Lupe said that her daughter doesn't speak Tagalog. Mang Lupe told me his story in smattering Tagalog. From my own experience of communicating with poor people, I have already developed an acute sense of who might be telling the truth or lie. In the manner in which Mang Lupe told me his story, I knew that he was telling me the truth. I invited them for a lunch at a nearby fast food outlet. Since I didn't have enough money to provide for their complete fare, I decided to help with what little money I have in my pocket--plus I wrote down on a piece of paper a little note asking for help from the pedestrians in the underpass. I then bid my goodbye and wished them the best--hoping in my heart of hearts that there would be enough kindhearted people to help them to go back home.

The next morning (Saturday), I returned to Quiapo to check what happened to them. The night before, I was thinking of them--what happened to them? My conscience was torturing me that I hadn't helped enough. Why had I not invited them to my house? Now I must see to it that they get home. But Mang Lupe and Nina were no longer in the Quiapo Underpass when I returned there. I felt devastated. The other beggars, however, told me that Mang Lupe and Nina earned enough money begging yesterday and was now on their way back in Compostela Valley. I heaved a sigh of relief. God bless them.

I have to say finally that there are still many kindhearted souls in this world who will help a lost father and daughter find their way home.

A mother and daughter take a pitiful look at a lost father and daughter

Another Reason To Hate Patricia Heaton

Patricia Heaton was on "Who Wants To Be A Millionaire" a few night ago, and royally embarrassed herself in front of America and Regis Philbin.

If you want to skip the informal small talk crap and get straight to the ridiculousness that is Patricia Heaton, skip to the 3:00 mark in the video....

Parallel Parking

My wife was born and raised on the east coast. She had to parallel park their gigantic Dodge Ram Van every day, into teenie tiny parking spaces on busy streets.

I was born and raised on the west coast. I don't get the opportunity to parallel park very often. And when I do have the chance to squeeze my truck in between two other cars, it usually takes me three or four tries until I give up to go find another spot or I succeed (while my wife either laughs or yells at me).

This kid flawlessly parallel parks his monster truck in between his parents cars. He's four years old and he's already a better driver than I am....

Acute right MCA ischemic infarction

Findings

Initial noncontrast Head CT obtained 4 hours after symptom onset shows hyperdense middle cerebral artery sign (left image) in the proximal right middle cerebral artery. There is subtle loss of differentiation between cortical gray matter and subjacent white matter in the right MCA distribution, including the insular cortex (insular ribbon sign).
CT Angiography obtained 2 days after the onset of symptoms confirms an absence of blood flow distal to the right MCA M1 segment occlusion (right image below). Opacification of distal MCA branches is seen through pial collaterals.
Repeat CT Head 6 days after the onset of symptoms (right image) demonstrates continued evolution of large right MCA ischemic infarction, with a large area of hypodensity with loss of gray-white matter differentiation and effacement of cortical sulci in the right MCA distribution.


Diagnosis: Acute right MCA ischemic infarction


Causes of ischemic stroke:
- Cardiac emboli
- Atherosclerosis
- Coagulopathy
- Amyloid angiopathy
- Vasculitis
- Hypercoagulable state
- Venous thrombosis
- Arterial dissection
- Drug abuse

Differential diagnosis for clinical presentation of acute ischemic stroke:
- Subdural hematoma
- Intracerebral hemorrhage
- Cerebritis
- AVM
- Neoplasm
- Hemiplegic/hemisensory migraine
- Transient ischemic attack


Key points

Stroke is the 3rd leading cause of death in the United States, with the mortality rate from each episode estimated between 15%-35%.
The middle cerebral artery is the most common major vessel involved, with 75% of ischemic infarctions arising in the MCA territory.
Pathophysiology: Ischemia from vascular occlusion or hypoperfusion leads to cascade of cellular events resulting in failure of membrane pumps, causing efflux of potassium ions and influx of calcium ions, sodium ions, and water. This leads to cytotoxic edema, which can be detected on imaging studies as increased water content in the affected area.
The imaging characteristics of cerebral infarction are caused primarily by changes in brain water. This causes hypoattenuation on CT, low signal on T1-weighted MR images, and high signal on T2-weighted and diffusion-weighted MRI.
Noncontrast CT represents an important branching point in the work-up of suspected stroke. Its chief utility is detecting the presence or absence of hemorrhage, which contraindicates thrombolytic therapy.
Abnormalities on non-contrast CT can be seen between 3 and 6 hours after vessel occlusion in 60% of patients. The sensitivity for detecting ischemic stroke improves markedly by 24 hours after the event.

Early signs of ischemic MCA infarction on CT:
- Hyperdense middle cerebral artery sign: The actual thrombus can be visualized as a hyperdense focus within the vessel in 35-50% of acute MCA occlusions.
- Insular ribbon sign: Loss of gray-white differentiation in the insular cortex.
- Lentiform nucleus edema sign: Hypoattenuation from early edema in the putamen.
- Subtle effacement of cortical sulci (only 8% in early acute phase).
- Calcification within a vessel wall or high hematocrit level in normal arteries can mimic the hyperdense vessel sign.
- Hemorrhagic transformation occurs in 15% of MCA infarcts.

Spontaneous lumbar epidural hematoma-MRI

These are sagittal MRI T1 and T2 weighted images of lumbar spine revealing posterior epidural hematoma which was surgically confirmed and drained. This old patient presented with sudden onset paraparesis. Appearance was isointense to hypointense on Ti weighted image and hyperintense with hypointense areas on T2-weighted images which are highly suspicious for the diagnosis.

Citizen Of The Day #2

Nate Hill, a performance artist from Brooklyn, New York, has garnered quite a bit of attention for his actions.

Dressed in a white tuxedo and a dolphin headpiece, he transforms into he becomes his "Crackie". And every other Saturday night, between the hours of 10 p.m. and 2 a.m., he delivers $1 bags of "crack" - really crystallized sugar - to anyone who calls in an order in Williamsburg and Greenpoint, New York.

Just what we need, another large man dressed as a large dolphin in a tuxedo, selling fake crack to anyone who orders. This is becoming an epidemic!

Little Hands, Big Fish

This is fake, right? The video has become super popular all around the internet, but I just don't see how it can be real.... What do you think? The fish has to weigh as much as the little girl.

Isolated posterior element Potts spine -MRI

Spinal tuberculosis is more common in the eastern countries than in the western world. Recently, there has been a renewed interest in tuberculosis in the west because of its re-emergence, especially in immunocompromised patients (e.g., HIV). The classic radiologic picture of "two vertebral disease with the destruction of the intervertebral disc" is easily recognized and readily treated, but its atypical forms are often misdiagnosed and mistreated. In tuberculosis of the posterior element of the spine, MRI is extremely useful in evaluating the extent of involvement and response to therapy of isolated tuberculosis of posterior elements. Involvement of posterior elements due to tuberculosis is not so uncommon.

Further reading--Isolated tuberculosis of posterior elements of spine: magnetic resonance imaging findings in 33 patients. Spine (Phila Pa 1976). 2002 Feb 1;27(3):275-81

International Left-Handers Day!

That's right! August 13! It's International Left-Handers Day!

Approximately one in ten people in the world are left-handed. I did the calculations, I'd say around ten people read my blog regularly, including myself (because I'm just that narcissistic).

So, if one out of ten people in the world is left-handed.... Ten people read my blog (including me)..... I'm left-handed..... I really know how to write for my audience.

Now if you'll excuse me, Barack Obama, Angelina Jolie and I are going to go smudge some ink while we write our name in the guest book for the Left-Handers Party.... Left-Handers! Represent!

Mega Burger

These are straight from the McDonald's Japan website....

I introduce to you the "Mega Big Mac"

And the "Mega Tamago Burger". Three beef patties, one egg, bacon, cheese, lettuce and special sauce. All on a sesame seed bun.

Pancreatic Divisum-MRCP

MRCP FINDINGS:
Gallbladder is distended and there is no evidence of any filling defects within the lumen. Wall thickness is normal. There is no evidence of dilatation of the intrahepatic biliary radicles. Confluence of the right and left hepatic duct is patent. CBD is of normal caliber and no filling defect or calculus is seen within CBD. Dorsal pancreatic duct appears to open cranial to the opening of the CBD along with a small ventral pancreatic duct opening with the CBD in the region of major papilla. This may indicate a diagnosis of pancreatic divisum, further in view of history of recurrent pancreatitis. There is some beading in the pancreatic duct in pancreatic tail region. ERCP is suggested. Reported by Teleradiology Providers

Dog Won't Take Treats From Obama

What does Obama have to do? Can he make nobody happy? Why is the dog too proud to accept government aid?

Olfactory Meningioma

Findings

Axial non contrast enhanced CT shows a large lesion isointense to the brain in the frontal lobes crossing the midline.
Contrast enhanced axial image shows avid contrast enhancement of the lesion.
T2W axial image shows a mixed signal large lesion with little surrounding edema.
Proton density axial image shows a lesion which is largely isointense to the surrounding brain parenchyma.
The lesion is low signal on TIW image with marked contrast enhancement.
Post contrast TIW sagittal image shows the lesion to be extra axial with contrast enhancement.


Diagnosis: Olfactory Meningioma


Meningiomas are the most common extraaxial tumor. The features which suggest an extraaxial etiology are tumor relationship to the dura, local bony hyperostosis, corticomedullary buckling, displacement of the cortex away form the bone, preservation of the grey/white matter junction and widening of the cisterns. Meningiomas are located in a supratentorial location in about 90% of cases, most commonly at the convexity of the hemispheres. Meningiomas are more common in females.

On unenhanced CT, meningiomas are mostly hyperdense with intense homogenous uniform enhancement. They may be associated with hyperostosis of the adjacent bone. In most cases the surrounding edema is minimal, another feature which distinguishes it from an intraaxial lesion. The dural tail sign is a non-specific sign but one that suggests a meningioma. On MR, meningiomas are isointense to hypointense on TIW images with marked contrast enhancement. On T2W images they are isointense to slightly hyperintense in signal.

The multiplanar imaging capability of MR is useful in defining the exact anatomical location of the lesion.

The olfactory groove meningioma accounts for about 10% of intracranial meningiomas. They arise in the midline between the crista galli and tuberculum sella. Olfactory groove meningiomas may be symmetrical around the midline or extend to one side or the other. 10 to 15% grow into the ethmoid sinuses. They may present with anosmia, personality change, psychological effects, epilepsy and other frontal lobe symptoms. When large they may involve the visual pathways causing visual field defects. They are slow growing tumors frequently reaching large size before detection.