2/Older pt w/lower extremity numbness. MRI showed intradural, extra-axial rounded lesions in the lower thoracic region that avidly enhanced on post-contrast imaging—like gang busters enhancement
3/On the T2 weighted images, the lesions showed a very distinct donut-like appearance, with a very dark, almost black rim and a bright center.
4/On contrast imaging, the donuts were connected as twisty, tubular structures—my fellow said they looked like crinkle fries! (and yes, I know McDonald’s doesn’t serve crinkle fries as illustrated, but it’s just an illustration—there aren’t fries in the spine either 😉)
5/Tubular sounds like a vessel! And these did empty out into the neural foramina. But the spinal angio was negative for a vascular lesion (not all images shown—normal studies don’t make for good twitter images)
6/These are intradural varices! B/c of slow flow, they may not fill on angiography & lose their flow void centrally—causing a“donut sign.” Etiology is unclear, but likely acquired
So the next time you see donuts & fries in the spine—you can be sure you've got the right diagnosis
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1/Having trouble remembering what you should look for in vascular dementia on imaging?
Almost everyone worked up for dementia has infarcts. Which ones are important?
Here’s a thread on the key findings in vascular dementia!
2/Vascular cognitive impairment, or its most serious form, vascular dementia, used to be called multi-infarct dementia.
It was thought dementia directly resulted from brain volume loss from infarcts, w/the thought that 50-100cc of infarcted related volume loss caused dementia
3/But that’s now outdated. We now know vascular dementia results from diverse pathologies that all share a common vascular origin.
It’s possible to lose little volume from infarct & still result in dementia.
So if infarcts are common—which contribute to vascular dementia?