I'm Fucking.......

You’ve all seen the Fucking Matt Damon and Fucking Ben Affleck videos, but check out the Fucking Seth Rogen video.... It’s equally as funny.

Rabies encephalitis

Additional clinical information: Further investigation revealed that the patient had been bitten by a bat while playing in her neighborhood approximately 3 months prior to admission.


Findings

The head CT demonstrates diffuse cerebral edema, with findings of uncal herniation. Brain MRI showed multiple foci of restricted diffusion, including involvement of the right basal ganglia, thalami, and white matter. MRA demonstrates thrombosis of the left transverses sinus. MRA (arterial) of the brain suggested narrowing of the major intracranial vessels.

Differential Diagnosis:
- Viral encephalitis
- Carbon monoxide poisoning
- Leigh syndrome
- Infiltrating neoplasm

Fluorescent antibody and PCR were tested, which were positive for rabies. The child did not recover. Post mortem evaluation was consistent with rabies encephalitis.


Diagnosis: Rabies encephalitis, confirmed by laboratory evaluation and post mortem autopsy


Discussion

Rabies is caused by a RNA virus in the rhabdovirus family. The diagnosis of rabies encephalitis is clinical. Presenting symptoms may be non specific, but there is a typical presenting history of recent bat or other wild animal bit. The incubation period is between one and three months. According to the CDC, there have been only 6 documented cases of human survival from clinically evident rabies. Imaging is usually not performed because of the fatal and fulminate course

On imaging, the encephalitis form of human rabies demonstrates involvement of the brainstem, hippocampi, thalami, basal ganglia, and white matter. There is variable enhancement, and there is frequently restricted diffusion and diffuse cerebral edema. Intracranial arterial narrowing has been described in case reports.

Patients with carbon monoxide poisoning classically presents with abnormalities of the globus pallidi, with hypodensity on CT and hyper intensity of T2 weighted imaging. There is usually associated immediate neurological deficits, which persists over time.

Leigh syndrome is a mitochondrial disorder resulting in progressive neurologic deterioration. Adult presentation is unusual, with the majority of patients presenting by 2 years old. Imaging demonstrate bilateral hyper intensities involving the putamina and peri-aqueductal gray matter.

Diffusely infiltrating astrocytoma is usually unilateral and do not demonstrate restricted diffusion. There is variable enhancement.

Dan Whitney

Ok, so there’s this Dan Whitney. Fucking douche. He’s a comedian? (The question mark at the end of that sentence is intentional.)


Dan Whitney is better known as Larry the Cable Guy. This guy was horrible as Dan Whitney and is now horrible as Larry the Cable Guy. I was recently informed by someone in my office, that he or she is going to pay money to rent "Witless Protection" when it comes out on DVD. What the hell is happening to this world? I want to go down to the theater and find people who have bought tickets for this film, and punch them in the face.

The person that works in my office made the argument that Larry the Cable Guy is as funny as Jeff Foxworthy. I’m not a huge fan of Jeff Foxworthy, but he’s a very intelligent and funny man. This Larry the Cable Guy is a waste of space on Earth and deserves to die a horrible painful death. Why is this guy paid money?

And what the fuck does "GIT-R-DONE" mean?

"Have you ever farted so hard that it made your back crack?"

"They say cellphones put microwaves in your body. This guy used one and pooped out a hot pocket"

Woman in car: "Are you insane?" Larry the Cable Guy: "No, I’m Larry!"

Fuck you Dan Whitney.

Carotid Cavernous fistula (C-C fistula)

Findings

Figure 1: A non-contrast axial image through the upper orbits demonstrates an enlarged right superior opthalmic vein. Compare this vessel to the normal left superior opthalmic vein.
Figure 2: This image demonstrates proptosis, an enlarged medial rectus muscle, and a dilated superior opthalmic vein.
Figure 3: One slice below, we see enlarged medial and lateral rectus muscles.


Diagnosis: Carotid Cavernous fistula (C-C fistula)


A carotid cavernous fistula (C-C fistula) is a direct communication between the intracavernous portion of the carotid artery and the venous cavernous sinus. It is typically a result of trauma, either penetrating or non-penetrating, or a ruptured intracavernous carotid aneurysm. Other less common causes include Ehlers-Danlos and fibromuscular dysplasia due to intrinsic weakening of the vessel wall. This abnormal communication is most often found unilaterally. A patient with a C-C fistula usually presents with an eye motility disturbance, proptosis, an orbital bruit, and/or chemosis. Venous tributaries may connect the right and left cavernous sinuses, so that occasionally symptoms can be bilateral.

The pathophysiology of a C-C fistula begins with the release of arterial blood into the low-pressure cavernous sinus. The high arterial pressure decompresses into any venous structure that communicates with the cavernous sinus. Retrograde venous drainage leads to enlarged ophthalmic veins followed by venous congestion. The congestion causes an increase in the size of the extra-ocular muscles and orbital fat infiltration. This creates orbital mass effect and proptosis.

A CT examination demonstrates enlargement of the extra-ocular muscles, proptosis, and an enlarged superior opthalmic vein. A distended cavernous sinus can also be seen within the middle cranial fossa. MR imaging shows similar findings with the added ability to determine whether there is flow within opthalmic veins or if thrombosis has developed. MRI also allows for the detection of a carotid cavernous aneurysm if it is present. Catheter angiography of the external and internal carotid arteries and the vertebral arteries is necessary for accurate identification of the fistula; the lateral projection of the cranium is the most helpful. The angiographic appearance of a C-C fistula shows early, immediate, filling of the cavernous sinus and the dilated superior ophthalmic vein.

Although C-C fistulas can thrombose spontaneously, they are usually treated via an endovascular approach. The first option in treatment consists of using detachable coils or balloons, flow directed through the fistula into the cavernous sinus. Once within the sinus, the coils or balloons would tamponade the hole. If this doesn’t work, then another option would be to trap the fistula above and below its origin with balloons and/or surgical intervention.

Dural malformations involving the cavernous sinus can present with similar findings, but they differ from C-C fistulas in that they are not usually related to a traumatic event and the symptoms are not usually as severe.

Diastematomyelia of cervical spine

Findings

T2 images demonstrate complete splitting of the cervical spinal cord into 2 complete hemicords without associated syrinx. The cord splits just caudal to the medulla and reunites distally at the upper thoracic spine. There are associated cervical segmentation anomalies, including intersegmental laminar and vertebral body fusion, without a dividing spur.

Differential Diagnosis:
- Diastematomyelia
- Myelomeningocele
- Syringomyelia
- Diplomyelia


Diagnosis: Diastematomyelia of cervical spine


Key points

Diastematomyelia usually presents in childhood with a female predilection. Adult presentation is rare, but when patients present older, there is a slight male predilection. Patients usually present with stable or progressive disability, scoliosis, and neurologic and muscular abnormalities. Often, Diastematomyelia is clinically indistinguishable from a tethered cord.
Treatment consists of surgical tethered cord release, spur resection, scoliosis correction, and dural repair.
Diastematomyelia occurs between T9 and S1 85% of the time.
Diastematomyelia often occurs when a fibrous osseous spur splits the cord sagittally into 2 hemicords that usually unite cranial and caudal to the cleft. In the patient presented above, the salient lesion was a lipoma, which was surgically resected.
85 % of Diastematomyelia patients have associated congenital spinal anomalies such as segmentation and fusion anomalies, intersegmental laminar fusion, dysraphism, tethered cord, syringohydromyelia, scoliosis, and Chiari II malformations. Intersegmental laminar fusion is virtually pathognomonic.
Meningocele manqué – Tethered cord due to nerve roots adhering to the dura.
Half of diastematomyelia patients present with cutaneous stigmata such as a "fawn's tail" hair patch at the level of the lesion.


Pang Classification

Type I Split cord malformation
- Separate dural sac
- Osseous spur
- More commonly symptomatic

Type II Split cord malformation
- Single dural sac
- No osseous spur, may see adherent fibrous bands tethering cord
- Usually asymptomatic unless associated with tethering or hydromyelia

Marilyn Monroe Photo

So, Mr. Lawrence Nicastro owned a service station in the Bronx for many years of his life. In 1962, a customer dropped off a car for service and never returned. Mr. Nicastro eventually emptied the contents of the car into a storage unit and sold the car.

When recently looking through the contents of the car placed in the storage unit, he found a rare picture of Marilyn Monroe, nude, hitchhiking, in heels, with a cigarette hanging out of her mouth. Mr. Nicastro decided to do a little research and got in touch with Mr. Chris Harris, a publicist and Marilyn Monroe expert. Over four months, Mr. Harris verified the authenticity of the Marilyn Monroe photo.

Mr. Nicastro and Mr. Harris set up a press conference, prepared to soak in the praise and the dollars from the press for this rare photo. The day before the press conference, they decided to give the Associated Press reporters a sneak peek. When the sheet was taken off of the rare Marilyn Monroe photo, one Associated Press reported cocked his head quizzically and said "Hey, that’s Madonna." Mr. Harris sheepishly looked at the photo one more time and said "You’re right, it’s Madonna."

Radiology Mistakes on TV

How many of us radiologists notice this on TV and cinemas every now and then! A very interesting blog post by Mike Enriquez in Advanceweb Magazine wherin he says--"The number of times I have seen radiographs incorrectly placed on the view box in one of these shows is way too many. I mean, basic stuff that the show producers just can't seem to get right! Numerous PA chest images have been shown reversed! How about when AP Abdomen Flat Plate images are viewed upside down? And, then, there are the insults to technical quality! Ever notice how any time you are shown an AP skull image and the entire image receptor has been exposed? Not any signs of collimation or a R/L marker anywhere to be seen!"