#FOAMrad#neurorad#HUNSC#daybydaycases
Two patients with a similar clinical profile: elderly men with prostatic adenocarcinoma.
Similar neuroimaging pattern: dural base lesion with intense enhancement and vasogenic edema.
But with different etiology .....
A: Meningioma
B: Dural metastases (DM)
DM in isolation is rare, comprising <1% of all intracranial metastases, and most commonly originates from renal, lung, and breast cancer, as well as carcinoid, adenoid cystic carcinoma, prostatic adenocarcinoma (PCa), and dermatofibrosarcoma
Transdural metastases may mimick meningiomas in radiologic imaging, especially in patients with undiagnosed symptoms of prostatism or PCa.
In older men with dural lesion(s), a possibility of PCa metastases must be considered and radiologic evaluation
CNS Involvement in Non-CNS Tumors
F. Barkhof et al. (eds.), Clinical Neuroradiology, doi.org/10.1007/978-3-…
Primary Progressive Multiple sclerosis (PPMS).
A MS course characterised by steadily increasing from disease onset.
Objectively documented neurological disability independent of relapses.
Fluctuations, periods of stability, and superimposed relapses might occur
Primary Progressive Multiple Sclerosis can be diagnosed in patients with:
• 1 year of disability progression (retrospectively or prospectively determined) independent of clinical relapse
Plus two of the following criteria
• One or more T2-lesions characteristic of MS in one or more of the following brain regions: periventricular, cortical or juxtacortical, or infratentorial
• Two or more lesions in the spinal cord
• Presence of CSF-oligoclonal bands
#FOAMrad#radres#neurorad
Cerebral Edema
Is an excess accumulation of water in the intracellular and/or extracellular spaces of the brain
Is a common response to various forms of brain injury, and the causes can be categorized as cytotoxic, vasogenic, interstitial, or combined
Cytotoxic edema
• Is cell swelling caused by damaged molecular sodium–potassium ATPase ion pumps. It can affect both gray and white matter.
• Is caused by cell death, most commonly due to infarct or excitotoxic (secondary to excessive neurotransmitter stimulation) brain injury.
Vasogenic edema
• Is interstitial edema caused by increased capillary permeability, by breakdown of the tight endothelial junctions comprising the BBB, secondary to either physical disruption or release of vasoactive compounds
• It is seen primarily in the white matter
PML in MS
Progressive multifocal leukoencephalopathy (PML) is an opportunistic infection of the CNS caused by John Cunningham virus (JCV)
PML in the setting of monoclonal antibody therapy has attracted tremendous attention particularly in MS patients treated with natalizumab/NTZ.
Features favoring PML over MS (as proposed by Yousry et al) are the following: 1) Diffuse subcortical rather than periventricular white matter involvement; frequent involvement of posterior fossa. 2) Irregular ill-defined infiltrating edge confined to the white matter.
3) Persistent progression of the lesion confined within the white matter tract. 4) No mass effect even in large lesions. 5) Diffuse increased T2 signal intensity; recently involved areas more T2 hyperintense than the old areas.