CO Poisoining-MRI

Bilateral globus pallidus hyperintensity is characterstic of CO poisoning. In this case this was an obscure case clinically and diagnosis of suspected retrospectively after MRI was done.

Reported by- Teleradiology Providers.

Can You Guess This TV Theme? #34 - Answer

Did you guess 'Three's A Crowd'? The spin-off of the wildly successful 'Three's Company' was on the air for only one season back in 1984-1985, and was canceled to make room on ABC's schedule for 'Diff'rent Strokes'....

John Ritter and Mary Cadorette, as Jack Tripper and his girlfriend Vicky Bradford, try to maintain a relationship while living together above Jack's restaurant (Jack's Bistro).... Trying to throw a wrench in the gears is Vicky's unapproving father, Jack Bradford (played by Robert Mandan), who buys the building where Jack has his restaurant, and starts to meddle in Jack and Vicky's relationship.... Hilarity ensues!

As an added bonus, the producers decided to add Alan Campbell as E.Z. Taylor, Jack's 'surfer dude' assistant chef, however, there were no cameos from either the Ropers, Janet or Chrissy....

Can You Guess This TV Theme? #34

It's Friday! You know what that means! Welcome back to another exciting edition of "Can You Guess This TV Theme?"!

Sarcoidosis involving the lacrimal glands

Findings

Axial (Figure 1) and coronal (Figure 2) non contrast CT images, as well as an axial T2 MRI image (Figure 3), demonstrate symmetrically enlarged lacrimal glands which protrude anterior to the lacrimal fossa bony contours. Homogeneous enhancement is identified on the selected contrast enhanced axial CT image (Figure 4). There is no evidence of adjacent bony orbit invasion. An AP chest radiograph (Figure 6) demonstrates predominantly right hilar lymphadenopathy with “eggshell” calcification and bilateral reticulonodular opacities within the lung parenchyma.


Diagnosis: Sarcoidosis involving the lacrimal glands


20 to 25 percent of patients with systemic sarcoidosis develop ophthalmic manifestations usually between the third and fifth decades. The most common finding is inflammation of the uveal tract. Less commonly, patients will present with inflammation of the optic nerve or orbital involvement including pseudotumor like intraorbital masses, extraocular muscle enlargement, or lacrimal gland infiltration and hypertrophy. Isolated orbital disease is uncommon and usually limited to the lacrimal glands.

Lacrimal gland involvement occurs in approximately 15-28% of patients; usually as painless bilateral gland swelling evident on physical examination. In many cases, lacrimal gland involvement may occur long before lung and other organs are affected, thereby aiding in the early diagnosis of systemic sarcoidosis.

Imaging studies such as orbital CT and MRI are an integral part of early diagnosis. CT findings include symmetric enlargement of the lacrimal glands with diffuse homogeneous post contrast enhancement. There may be associated medial displacement of the optic globes as well as proptosis. Pertinent negative findings include the absence of adjacent bony orbital invasion and destruction. MRI is optimal to evaluate for additional orbital involvement such as optic nerve infiltration which manifests as a thickened and enhancing intraorbital nerve. An MRI of the brain is also recommended to evaluate for extension into the intracranial optic pathways and to exclude findings of coexisting neurosarcoidosis.

While diagnostic imaging tests may reveal findings highly suggestive of lacrimal gland sarcoidosis; definitive diagnosis requires biopsy of the glandular tissue and histopathologic assessment. Noncaseating granulomas characterized by clustered epithelial cells, central giant cells and abundant surrounding lymphocytes are characteristic.

The mainstay of therapy is high dose systemic steroids, usually oral prednisolone for approximately two weeks, followed by gradual tapering after the inflammation appears controlled. Some patients may require maintenance doses for several weeks to months.

My So Called Reunion

In what could be my favorite reunion of all time, Claire Danes and Jared Leto (Angela Chase and Jordan Catalano from My So Called Life) were photographed together for the first time in 15 years at the Elle Fashion Awards in London.


By the way, if you've never seen My So Called Life, the entire series (only 19 one hour episodes) can be seen at HULU.... You'll go directly to the show's page if you click on the picture below....

Spinal meningioma

Findings

There is a contrast enhancing extramedullary, intradural lesion at T6.

Differential diagnosis:
- Meningioma
- Schwannoma
- Drop metastases
- Arachnoid cyst


Diagnosis: Spinal meningioma


Key points

Meningiomas are dural based, benign, slow growing tumors. They are usually solitary lesions and are 8 times more likely to occur in the brain than the spinal cord. When in the spinal cord, the thoracic spine is affected 80% of the time. On pathology, meningiomas are usually firm, round and well demarcated. Meningiomas have a peak incidence in the 5th and 6th decades of life. Presenting symptoms are usually due to mass effect the tumor has on adjacent neural tissue and can include pain, motor or sensory deficits.

Meningiomas are usually WHO grade I tumors (95%) and treated with surgical excision. In this case, the patient presented with back pain. She subsequently underwent resection of her tumor without recurrence.


Radiology

Meningiomas are well circumscribed, strongly enhancing lesions. On non-enhanced CT, meningiomas are difficult to recognize and usually isodense to mildly hyper dense when compared to surrounding brain parenchyma. With contrast, meningiomas enhance homogeneously. On T1 and T2 weighted images, meningiomas are Iso intense in relation to the spinal cord. Some meningiomas are well vascularized and may demonstrate flow voids on T2 images. Meningiomas have well defined borders and do not invade adjacent neural tissue.

In this case, there is a solitary, intradural, extramedullary, homogeneously enhancing lesion in the mid-thoracic spinal cord. In an older female patient, meningioma is the likely diagnosis. Other intradural, extramedullary lesions include schwannoma, drop metastases, epidermoid, arachnoid cyst, and paraganglioma.

Schwannomas are nerve sheath tumors and have imaging characteristics similar to meningiomas. They usually occur in younger patients and can have a dumbbell shape as the tumor encases the nerve root across the neural foramen. In drop metastases, multiple contrast enhancing lesions are seen in the cord. Arachnoid cysts can cause mass effect similar to meningiomas, but are fluid filled structures that demonstrate no contrast enhancement. Epidermoid cysts are lobulated structures that minimally enhance and rarely occur in the spine. Paragangliomas rarely occur in the spine and occur in the cauda equina when they do.

Captain EO Is Back!!!

Did anybody else watch the Michael Jackson 'This Is It' movie? It really wasn't what I expected.... I wasn't expecting the Michael Jackson that I saw on stage. He wasn't the Michael Jackson that you saw in the tabloids. He was in control of everything.... He knew who, where, when and what he wanted and he knew why he wanted it.... And if it weren't for his untimely death, I think it would have been an impressive concert tour.

Anyway, way back in the day, Michael Jackson starred in a little 3D film that was directed by Francis Ford Coppola and produced by George Lucas, called 'Captain EO'. The film stars Michael Jackson as the leader of a 'rough-around-the-edges' crew headed into space to deliver a gift to the 'Witch Queen' and was a vehicle for the debut of two of Michael Jackson's best songs: 'We Are Here To Change The World' and 'Another Part Of Me".

Now, you couldn't see 'Captain EO' in any old theater.... You could only see the film in Disney parks, and sadly, the movie was removed from Disneyland in 1996. This was one of the must see attractions at Disneyland!

Well.... It's back!!!!! Captain EO came back to Disneyland in full remastered glory yesterday, February 23, 2010! Now, I know that most everybody will not be able to make it out to California to see Captain EO, so I present to you the regular video and the 3D version! Seriously, if you have the glasses, watch the 3D version! Oh, and you need the old school red and blue 3D glasses, not the new Avatar 3D type glasses!

REGULAR VERSION

3D VERSION

Life Before Google

The good people over at ShoeBoxBlog.com have possibly created one of the funniest comic panels ever!


Seriously, what did we do before Google? Or Wikipedia for that matter?

I remember having to use something called an encyclopedia when I was in high school.... Remember pulling each 70 pound volume off of the shelf, just to learn a random outdated fact about the population of South Dakota?


I wonder what school was like before calculators were invented? We really do have it easy, don't we? Are we too reliant on the internet?

I'm On A Horse

Back in the olden days, when I was a child, my dad would slap on Old Spice after shave every morning. I remember the white bottle sitting on my parent's bathroom counter. I can barely remember how the after shave smelled, but I remember my dad's customary four slaps on his face, then shaking his hands in the air to get the remaining after shave off of his hands....

Anyway, the marketing geniuses at Old Spice have created one of the best commercials ever! We're not a commercial watching family (The Digital Video Recorder is man's greatest invention!), so I have to give my wife credit for pointing out this commercial....

It's their best commercial since their Neil Patrick Harris commercials! He should know whether or not Old Spice is a good product, he used to be a doctor for pretend!

May Contain Traces Of Peanuts

Possibly the best wordplay ever!

Rasmussen encephalitis

Findings

Figure 1, Figure 2, and Figure 3: Atrophy of the left cerebral hemisphere and numerous punctate calcifications involving predominately the cortex of the left hemisphere.
Figure 4: Left sided perihemispheric areas of increased signal representing areas of wallerian degeneration.
Figure 5: Unihemispheric volume loss involving the left hemisphere.


Diagnosis: Rasmussen encephalitis


Rasmussen encephalitis is a rare progressive CNS disorder characterized by chronic inflammation, most commonly involving a single hemisphere of the brain. Although the exact cause of the disease remains unknown, there are several theories regarding its etiology. One theory suggests that the disease has an autoimmune component where the body produces antibodies which activate the brain’s glutamate receptors. Other theories suggest that the encephalitis is related to primary viral infection, or to secondary immune mediation in response to a viral infection.

The disease occurs most commonly in children under the age of 10. The disease progression is characterized by intractable seizures and progressive neurologic deterioration including loss of motor skills and speech. Patient presentation can be characterized into three phases. The first phase (prodrome stage), is characterized by mild hemiparesis, and low frequency seizure activity, which generally lasts for 7-8 months. The second phase (acute stage) is characterized by acute increase in seizures, progressive hemiplegia, and brain atrophy. Often, this occurs in the form of epilepsia partialis continua, a phenomenon considered the status epilepticus for simple partial motor seizures. During the third phase (residual stage), patients develop permanent hemiparesis, and continue to have many seizures (although less than in the acute stage).

On imaging, Rasmussen encephalitis appears as unilateral cortical atrophy on CT and MR. There may be cortical swelling initially, with atrophy that ensues. The distribution is variable, although in some cases the entire cerebral hemisphere may be affected. No enhancement is usually seen. On PET/SPECT, there is decreased cerebral perfusion and hypometabolism of the affected hemisphere. There may be crossed cerebellar diaschisis although this is nonspecific. EEG is recommended to characterize the seizures.

The treatment involves hemispherectomy since anti-epileptics are usually not effective at controlling the seizures. Alternative treatments include plasmapharesis to remove the antibodies against glutamate receptors. Prognosis is poor with most patients inevitably developing hemiplegia with or without treatment.

Baastrup's disease

Findings

There is diffuse disk desiccation and multilevel narrowing of the lumbar spine disc spaces with multilevel disc bulges or protrusion. There is close approximation of the spinous processes of the lower lumbar spine with sclerosis (low signal) and flattening of the adjacent spinous processes. There are focal fluid collections seen as high signal on the T2 sequence between the opposing spinous processes in the expected locations of the interspinous ligaments. These correspond with adventitious bursae and surrounding inflammatory changes. There are cystic changes of the L4 spinous process at the pseudarthrosis.


Diagnosis: Baastrup's disease


Key points

The clinical syndrome of pain in the back when standing erect which is relieved by bending forward was described in 1929. In 1933, Christian Baastrup, a Danish radiologist described in detail the clinical and radiological features of the syndrome. It manifests clinically as localized midline lumbar tenderness and pain on spinal extension that can be relieved by spinal flexion, local anesthetic injection and excision of part of the involved spinous processes.

Baastrups's disease is characterized on plain films by close approximation of spinous processes ("kissing spines") with associated sclerosis, enlargement and squaring off/ flattening of the involved spines. MR may document the development of adventitious bursae between the spines, seen as high signal fluid between the processes. This condition usually arises from chronic postural hyperlordosis and regional loss of discal spacings. Hypertrophy of the tips of the spinous processes may occur in the elderly persons especially in those with an occupational history of long periods of back flexion.

Synonyms: Arthrosis interspinosa, diarthrosis interspinosa, kissing osteophytes, kissing spine, kissing spinous disease, osteoarthrosis processus spinosi vertebrarum lumbalum, osteoarthrosis interspinalis

Can You Guess This TV Theme? #33 - Answer

They knew everything about everything when it came to academics, he was there to teach them lessons about life....

'Head Of The Class' focused on substitute history teacher Charlie Moore, played by Howard Hesseman of WKRP fame, and the diverse group of students in the Individualized Honors Program at Millard Fillmore High School.

The students in the IHP program included Robin Givens as speech and debate expert Darlene (pre- and post-Mike Tyson), Dan Frischman as mathematics expert Arvid, Khrystyne Haje as literature expert Simone, Tony O'Dell as political science expert Alan, Brian Robbins as leather jacket wearing and wisecracking Eric (currently an executive producer of Smallville), Sarah Nevins as Kimberly, Dan Schneider as physics and chemistry expert Dennis, and Tannis Vallely as 12 year old expert at everything Janice.

Did you know that 'Head Of The Class' is the first American sitcom to be filmed in the Soviet Union? Filmed in Moscow, the episode featured an Academic Olympics rematch with the Russian team.... SPOILER ALERT - USA WINS!!!! Sorry for ruining that for you....

There were two important late additions to the show, in the final season of the show, Scottish comedian Billy Connolly replaced Howard Hesseman as the teacher.

And the most important addition, and in my honest opinion, the reason that 'Head Of The Class' should still be on the air.... The addition of Jonathan Ke Quan as student Jasper Kwong! You may know him as 'Short Round' from the Indiana Jones films and 'Data' from 'Goonies'!!!!!

Can You Guess This TV Theme? #33

It's Friday! Note to Blogger users: If you plan on scheduling a post to publish at 7:00 a.m., make sure you click the 'Publish' button and not the 'Draft' button. Let's get to it.... Can You Guess This TV Theme?

Before They Were Famous #2

Everybody ready for a fun game to waste some time on a Thursday morning? Another game of "Before They Were Famous"! Can you recognize these stars from before their rise to stardom?

1.
2.
3.
4.
5.
6.
7.
8. 9. 10.
11.
12.

Let's see how you did.... Post your score in the comments!

1. George Clooney

2. Ryan Seacrest

3. Madonna

4. Jodie Foster

5. Brad Pitt

6. Bruce Willis

7. Vince Vaughn

8. Robert DeNiro
9. Sean Connery

10. Ben Stiller
11. Christopher Walken
12. Kate Hudson