Paul Madonna

Last week, while perusing the internet, I fell into the website of a Mr. Paul Madonna. Mr. Madonna is credited as being the first artist intern ever at MAD Magazine, and is an extremely talented artist with a very sharp wit. He currently writes a comic strip titled 'All Over Coffee' for the San Francisco Chronicle.

Anyway, I wanted to show some of his humorous sketches and direct you his way (to his site).... I think you'll enjoy him as much as I do.... Click his banner below to go to his site and check out the rest of his artwork....

Normal Pressure Hydrocephalus-MRI

1. Ventricular enlargement out of proportion to sulcal atrophy.
2. Prominent periventricular hyperintensity consistent with transependymal flow of CSF. 

3. Prominent flow void in the aqueduct and third ventricle, the so-called jet sign, (presents as a dark aqueduct and third ventricle on a T2-weighted image where remainder of CSF is bright)
4. Thinning and elevation of corpus callosum on sagittal images

Opinion by -Teleradiology Providers

Less Work and More Play

I figure that since people are actually enjoying the photos I take on my little work excursions, I'll try posting another one.... I was able to travel to the beautiful city of Watsonville to inspect a property a while ago.... While I was driving, the Martinelli's Apple Cider factory caught my eye. I had no idea that Martinelli's Apple Cider was made in this little town.


It's not a very big factory. I would have thought that the factory would be huge! But it's just a small factory, across the street from a high school.


Did you toast New Year's Eve with Martinelli's Apple Cider when you were a kid? I vaguely remember drinking Martinelli's Apple Cider while the adults all had their libations.


This shocked me.... I tried calling the family center at the park where Sotomayor Field is located, they have no idea who it was named for.


I'm just going to make up a story.... Supreme Court Justice Sonia Sotomayor was the 'Pele of the Bronx', so they named the park after her.... There you go, I could think of nothing funny to say about Sonia Sotomayor.


Finally, here's the vicious beast that was out of his cage when we inspected his home.

Fahr disease

Findings

Figure 1 and Figure 2: Select axial non-contrast CT images demonstrate dense symmetric calcification in the basal ganglia (Figure 1) and dentate nuclei (Figure 2). Cortical atrophy is also seen.
Figure 3: Axial T1-weighted image demonstrates symmetric cerebellar hyperintense foci corresponding to calcification seen on CT.


Diagnosis: Fahr disease (Idiopathic familial basal ganglia calcification)


Fahr disease (Idiopathic familial basal ganglia calcification, bilateral striopallidodentate calcification, Familial cerebrovascular ferrocalcinosis) is a rare disorder characterized by idiopathic basal ganglia calcification with associated cognitive and neurobehavioral manifestations.

Calcification is found primarily in the globus pallidus, but the putamen, caudate, thalamus, cerebellum (especially dentate nucleus), corona radiata, and subcortical white matter can also be affected. There are no detectable abnormalities of calcium or phosphate metabolism. Patients develop progressive parkinsonism, dystonia, and neuropsychiatric disturbance.

There is a bimodal pattern of onset. Those affected in early adulthood may be asymptomatic in the first two decades, despite the presence of basal ganglia calcification. The disease presents with schizophreniform psychosis. A second peak of onset is seen in late middle age, when patients present with subcortical dementia or Parkinsonian symptoms, which are permanent and progressive. Paroxysmal dystonic choreoathetosis and seizures are common. Eventually patients develop symmetrical spastic paralysis progressing to a decerebrate state.

The disease process involves the deposition of calcium in the walls of the capillaries and larger arteries and veins. Other elements, including magnesium, zinc, aluminum, and iron have also been found deposited in the vessels. No definitive treatment is available.

In studying a three-generation family with an autosomal dominant form of the disease, Geschwind et al, established that the chromosomal locus, IBGC1, lies on chromosome 14, and found that this form of the disease demonstrates genetic anticipation. Autosomal recessive inheritance has also been documented. The disease demonstrates variable expressivity.

CT images demonstrate bilateral, symmetric calcification in the globus pallidus, cerebellum, and white matter. On T1-weighted MR images calcifications are hyperintense, while on T2-weighted and FLAIR images, calcification may be hypo- or hyperintense. T2 hyperintense regions in the white matter, which do not correspond to calcification can also be seen. This finding may reflect progressive inflammation.

Differential diagnosis for inherited and acquired basal ganglia calcification
Postinflammatory causes:
- Tuberculosis
- Toxoplasmosis
- Cystercercosis
- Congenital HIV

Endocrine causes:
- Hyperparathyroidism
- Hypoparathyroidism
- Pseudohypoparathyroidism
- Hypothyroidism

Congenital causes:
- Tuberous sclerosis
- Down syndrome
- MELAS
- Neurofibromatosis

Toxic causes:
- Exposure to carbon monoxide
- Chemotherapy
- Radiation therapy
- Lead intoxication

In addition, incidental basal ganglia calcification is seen frequently on CT imaging in patients over the age of 50.

Levator claviculae muscle-CT appearance of an unusual variant

The levator claviculae muscle is an infrequently recognized variant in humans, occurring in 2% to 3% of the population, and has rarely been reported in the radiologic or anatomic literature. The importance of this muscle to radiologists is in distinguishing it from an abnormality; most commonly, cervical adenopathy. It arises from the transverse processes of the upper cervical vertebrae and inserts in the lateral half of the clavicle. Reference- AJNR Am J Neuroradiol 20:583–586, April 1999

Reported by Teleradiology Providers

Tiptoe Through The Tulips

Ok, one more about the Skagit Valley Tulip Festival.

Here are more pictures from one of the biggest tulip farms in Skagit County, Washington. Roozengaarde was established in 1985 by the Roozen family and the Washington Bulb Company. The Roozen family business of growing tulips, daffodils and irises is the largest in the world, covering Skagit Valley with more than 1,200 acres of field blooms and 15 acres of greenhouses. The driving force behind Roozengaarde was Bernadette Roozen Miller, who passed away in 1996. Each fall, the 3 acre show garden is planted with over two hundred thousand spring-flowering bulbs, providing a gorgeous display of color during the early weeks of spring.

Two Lips

Last year, during a work trip to Skagit County, Washington, I was lucky enough to catch the tail end of the Annual Skagit Valley Tulip Festival.... Did you know that Skagit County is only second to Amsterdam in the production of tulips? Everywhere you look, you can see acres and acres of tulips! The Skagit Valley Tulip Festival is the hottest thing in the county from April 1st to April 30th. Here are some awesome pictures from the festival!