1/As my attending once said, “If I’ve seen it once, I’ve seen it…well once.”
A 🧵about an interesting case that I’ve seen once in 15 years and never again. #medtwitter #radres #FOAMed #FOAMrad #neurorad #Meded #Neurosurgery #HNrad
2/Pt with history only of diabetes came in with altered mental status. There were these super bright round balls in their ventricles. It looked like a snowman massacre happened, with big round snowballs in the ventricles
3/On MRI, these had intrinsic T1 hyperintensity w/chemical shift artifact--they looked like boba tea pearls floating in the ventricles. Typically, we think of chemical shift w/fat--but these were not fat on the CT!! They did not enhance & otherwise, brain was unremarkable for age
4/The answer is looking you right in the eye! This is intraventricular extension of silicone from a silicone retinopexy. Silicone dissections along the optic sheath into subarachnoid space & ventricles. It is typically asymptomatic. And now you've seen as many of these as me!😉
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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3/But that’s now outdated.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?