Fabry's Disease
47-year-old man with history of seizure, peripheral neuropathy, skin lesion, visual changes, cardiac murmur and proteinuria.
- Fabry's disease is a multisystem X-linked disorder of glycosphingolipid metabolism with deficient activity of α-Galactosidase A, leading to progressive accumulation of glycosphingolipid in vascular endothelium, perithelium, smooth muscle cells, brain, peripheral nerves, heart, skin and kidneys.
Hypertrophic Olivary Degeneration
38-year-old man with headache and dizziness.
- Hypertrophic olivary degeneration is a unique type of transsynaptic degeneration resulting in hypertrophy of degenerated inferior olivary neurons rather than atrophy.
- Most commonly occurs following focal lesions to the brainstem, such as hemorrhage, which in this case was related to a cavernous hemangioma.
Band Heterotopia
25-year-old woman with seizures.
- Heterotopia is the name given to focal or diffuse collections of ectopic neurons in the cerebral hemispheres, a neuronal migrational anomaly. It can be broadly classified into the subependymal, subcortical and band types of heterotopias.
- In general, band heterotopia is seen largely in women. Men with a mutation of the related gene (called XLIS or DCX) usually die in utero or have a much more severe brain anomaly.
- On MRI, it shows the characteristic 3-layers (double cortex), with a thin layer of white matter between the cortex and the heterotopic band. The cortex may be relatively normal or pachygyric.
Wernicke's Encephalopathy
- Wernicke encephalopathy (WE) is an uncommon neurologic disorder characterized by changes in consciousness, ocular dysfunction and ataxia.
- WE results from deficiency of vitamin B1 (thiamine) in patients with history of ethanol abuse, and in non-alcoholic patients the most frequent cause is intestinal malabsorption.
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