Bing-Neel syndrome is an extremely rare neurological complication of Waldenström macroglobulinemia where there is malignant lymphocyte infiltration into the central nervous system (CNS).
The exact incidence is unknown, however in one study of patients with Waldenström macroglobuli...
Biotinidase deficiency is a rare autosomal recessive condition in which the body is unable to break down the conjugated form of the vitamin B7 (biotin), resulting in low levels of available biotin.
Profound deficiency (<10% of normal level) is estimated at ~1:100,000 of newborns. ...
Birth trauma relates to those conditions caused by both physical/mechanical and hypoxic injuries.
Birth trauma occurs in ~5 per 1000 births 2.
Bilateral thalamic lesions usually seen in combination with basal ganglia and /or white matter and sometimes cortical lesions. Symmetrical bilateral involvement of the thalami has relatively limited differential diagnosis, including metabolic, vascular, toxic, ischaemic, infectious, or hypoxic c...
Neuroanatomy of the bladder is complex, described here is a summary of the co-ordination of micturition.
The bladder acts as a reservoir normally storing 400-500 mL of urine under low pressure (<15 cmH2O) before voluntary voiding can occur at a socially-convenient time. Bladder filling and empt...
The blend sign refers to a CT appearance of early intracranial haematoma growth. It is defined as blending of a hypoattenuating area and a hyperattenuating region with a well-defined margin.
The blood brain barrier (BBB) forms a physical resistance to the passage of lipophobic substances from cerebral capillaries into the brain and is a key reason why there is no CSF enhancement following IV contrast media in CT and MR imaging.
The BBB is formed by a combination of e...
The blood supply of the meninges generally concerns the blood supply of the outer layer of dura mater rather than the inner layer of dura mater, arachnoid or pia mater which do not require a large blood supply. There are several arteries that supply the dura in the anterior, middle, and posterio...
Blumcke et al. proposed the most recent (2011) 2 and now widely adopted consensus classification system for focal cortical dysplasia, which shares many features with the previously described classifications system by Palmini (2004) and Barkovich (2005).
Unfortunately, as is the case with many ...
Blunt cerebrovascular injury (BCVI) is an uncommon but serious consequence of blunt trauma to the head and neck.
It is often part of multi-trauma with a significant series of blunt trauma CTA reporting an incidence of approximately 1% 3. A large systematic review and meta-analysis...
Bochdalek's flower basket is the eponymous name for the incidental finding of protrusion of the choroid plexus through the foramina of Luschka. This is a relatively common finding.
It is an important normal variant to recognise as the presence of protruding calcified choroid tissue in the fourt...
Blood oxygenation level dependent (BOLD) imaging is the standard technique used to generate images in functional MRI (fMRI) studies, and relies on regional differences in cerebral blood flow to delineate regional activity.
Blood flow in the brain is highly locally controlled in response to oxy...
The boomerang sign refers to a boomerang-shaped region of cytotoxic oedema in the splenium of the corpus callosum typically seen in cytotoxic lesions of the corpus callosum (CLOCCs) 1-4.
boomerang sign in peroneus brevis split syndrome
boomerang sign in horizontal meniscal flap tear
The Borden classification of dural arteriovenous fistulas (DAVF) groups these lesions into three types based upon the site of venous drainage and the presence or absence of cortical venous drainage. It was first proposed in 1995 1. At the time of writing (July 2016), it is probably less popular ...
The Boston criteria were first proposed in 1995 in order to standardise the diagnosis of cerebral amyloid angiopathy (CAA) 1. They comprise of combined clinical, imaging and pathological parameters.
The criteria are divided into four tiers and are as 3-4:
full post-mortem examin...
Bouthillier et al. described (in 1996) 1 a seven segment internal carotid artery (ICA) classification system. It remains the most widely used system for describing ICA segments at the time of writing (mid-2016).
There are a few other classifications systems including those proposed by Fisher (1...
Brachial plexus injuries are a spectrum of upper limb neurological deficits secondary to partial or complete injury to the brachial plexus, which provides the nerve supply of upper limb muscles.
Trauma, usually by motor vehicle accidents, involves severe traction on the ...
Mnemonics for brachial plexus root subdivisions include:
Robbie T Drinks Cold Beer
Rugby Teams Drink Cold Beers
or Rad Techs Drink Cold Beer
Reach To Drink Cold Beer
Read That Damn Cadaver Book
Really Tired, Don't Care Now (nerve instead of branch)
Red Tits Don't Come Back (red-headed ti...
The bracket sign of the pars marginalis, also known as the pars bracket sign, refers to the appearances of the superior most extent of the pars marginalis of the cingulate sulcus on axial imaging. It forms two roughly symmetric brackets, open anteriorly. The next sulcus anteriorly is the central...
The bracket sign refers to a radiographic appearance seen with the tubulonodular variety of pericallosal lipoma. It reflects calcification seen at the periphery of the midline lipoma. It is best seen on coronal imaging and historically was identified on frontal radiographs.
It should not be con...
The brain is the vital neurological organ composed of:
The brain is housed in the skull and bathed in cerebrospinal fluid. It is continuous with the cervical spinal cord at the cervicomedullary junction.
Brain abscess is a potentially life-threatening condition requiring rapid treatment, and prompt radiological identification. Fortunately, MRI is usually able to convincingly make the diagnosis, distinguishing abscesses from other ring-enhancing lesions.
Demographics reflect at-ri...
Brain death refers to the irreversible end of all brain activity and is usually assessed clinically. Radiographic testing may be used as additional support for a clinical diagnosis of brain death, such as when clinical tests are impossible to perform, e.g. ocular trauma, precluding brainstem fun...
Brain development occurs from the three vesicles of the embryo's neural tube.
By approximately 4.5 to 5 menstrual weeks, the primitive neural plate has developed. The neural plate then divides into the neural crest and...
MRI protocol for brain infection assessment is a group of MRI sequences put together to best approach CNS infections in general.
Note: This article is intended to outline some general principles of protocol design. The specifics will vary depending on MRI hardware and software, radiologist's an...
This is a basic article for medical students and other non-radiologists
Brain mass lesions are a broad collection of pathological processes that result in changes on brain imaging (usually CT or MRI). They are a very disparate group of conditions ranging from infection (abscess) to brain tumour...
Brain metastases are estimated to account for approximately 25-50% of intracranial tumours in hospitalised patients. Due to great variation in imaging appearances, these metastases present a common diagnostic challenge which can importantly affect the management approach for individual patients....
The brainstem is the most caudal part of the brain. It adjoins, is structurally continuous with the spinal cord and consists of the:
pons (part of the metencephalon)
medulla oblongata (myelencephalon)
The brainstem provides the main motor and sensory innervation to t...
Brainstem gliomas consist of a heterogeneous group which vary greatly in histology and prognosis.
It should be noted that if not otherwise specified the term brainstem glioma usually refers to the most common histology, the diffuse brainstem glioma, and in children is most likely a...
The brainstem nuclei are the nuclei in the brainstem. These include:
the cranial nerve nuclei
Brainstem stroke syndromes, also known as crossed brainstem syndromes, refer to a group of syndromes that occur secondary to lesions, most commonly infarcts, of the brainstem.
Although many different brainstem stroke syndromes have been classically described, the majority appear e...
The brain MRI stereotactic study, also known as frame-based stereotactic MRI study or conventional brain MRI stereotaxis, is a localisation MRI protocol that delineates an intracranial structure or lesion in relation to a three-dimension coordinate system allowing a precise surgical access to th...
Brain stones, also known as cerebral calculi, refers to large intracranial calcifications that may be solitary or multiple.
If symptomatic, patients most commonly present with seizures.
Localisation of brain stones can help narrow the underlying aetiology bu...
MRI protocol for brain trauma is a group of MRI sequences put together to best approach traumatic brain injury, especially diffuse axonal injury.
Note: This article is intended to outline some general principles of protocol design. The specifics will vary depending on MRI hardware and software...
MRI protocol for brain tumour assessment is a group of MRI sequences put together to best approach CNS tumours in general.
Note: This article is intended to outline some general principles of protocol design. The specifics will vary depending on MRI hardware and software, radiologist's and refe...
Brain tumours arise from the normal constituents of the brain and its coverings (meninges). Spinal tumours are considered separately.
As a general rule, brain tumours increase in frequency with age, with individual exceptions (e.g. pilocytic astrocytoma, the vast majority of whic...
Common brain tumours in infancy (i.e. under one year of age) are quite different from those of brain tumours in adulthood:
intracranial teratoma (germ cell tumour)
primitive neuroectodermal tumour (CNS-PNET)
medulloblastoma (SHH and Group 3)
choroid plexus papilloma
The bright rim sign has been described in dysembryoplastic neuroepithelial tumours (DNET) and is seen, as the name so aptly describes, as a rim of high signal around the DNET on FLAIR sequences.
The pathologic correlate of this sign is glioneural elements loosely packed at the margin of the tum...
Brissaud-Sicard syndrome is a very rare pontine stroke syndrome that involves the anterolateral and inferior pons.
Classically, the syndrome presents as ipsilateral facial cramps and contralateral hemiparesis 1-3.
It has been postulated that the syndrome is ca...
Broca's area (Brodmann area 44) is an area of the lateral frontal lobe in the dominant hemisphere concerned with the production of speech.
Broca's area is located in the posterior inferior frontal gyrus (pars opercularis and pars triangularis) of the dominant hemisphere, anterior...
Brodmann areas are a system to divide the cerebral cortex according to cytoarchitectural organization, and are, despite controversy, still very widely used as a standardised nomenclature which is superimposed on the somewhat variable gyral and sulcal anatomy.
The classification relies on the f...
Brown-Séquard syndrome is the result of a hemicord lesion (i.e. damage or impairment to the left or right side of the spinal cord).
Due to some fibres crossing within the cord whilst others cross in the brainstem, the neurology is bilateral, namely 1:
The Brown syndrome refers to an inability of a patient to perform an upward gaze while the eye is adducted due to an abnormality of the superior oblique tendon sheath complex.
History and etymology
It was first described by Allan Brown in 1950 1.
Brudzinski sign occurs in meningitis (of any aetiology) where passive flexion of one leg causes flexion in the opposite leg. Passive flexion of the neck brings about flexion of the legs as well.
First described by Jósef Brudziñski (1874-1917), paediatrician from Warsaw, Pola...
Bruns sign occurs in patients with an obstructing fourth ventricle tumour. It consists of:
The symptoms are often exacerbated with sudden movements of the head
Buphthalmos is a descriptive term which simply means an enlarged eyeball or ocular globe due to increased intraocular pressure (glaucoma), without deformation or and intrinsic mass lesion.
It typically manifests in infants and young children.
It usually indicates the p...
A burnt out meningioma is a term used to denote a meningioma which has become completely calcified / ossified 1. The term refers to the usually indolent behaviour, with these tumours rarely seen to grow.
Most burnt out meningiomas are likely to be psammomatous meningiomas, as these are far mor...
Butterfly gliomas are a high grade astrocytoma, usually a glioblastoma (WHO grade IV), which crosses the midline via the corpus callosum. Other white matter commissures are also occasionally involved. The term butterfly refers to the symmetric wing-like extensions across the midline.
The butterfly sign refers to the normal appearance of the choroid plexuses on axial imaging of the fetal brain, commonly observed on the antenatal ultrasound. Its absence may suggest holoprosencephaly 1.
In the CNS, the term should not be confused with a butterfly glioma, which is a glioblastom...
Cerebral Autosomal Dominant Arteriopathy with Subcortical Infarcts and Leukoencephalopathy (CADASIL) is an autosomal dominant microvasculopathy, characterised by recurrent lacunar and subcortical white matter ischaemic strokes and vascular dementia in young and middle age patients without known ...
Café au lait spots are a type of pigmented skin lesions which are classically described as being light brown in colour.
Conditions associated with them include:
neurofibromatosis type 1 (NF1)
McCune-Albright syndrome: typically irregular which has been likened to ...
Caisson disease is an uncommon diving-related decompression illness that is an acute neurological emergency typically occurring in deep sea divers.
Diving-related decompression illness is classified into two main categories 3:
Arterial gas embolism secondary to pulmonary decompression barotra...
The calcarine artery, named according to its course in the calcarine fissure, is a branch of the posterior cerebral artery, usually from the P3 segment. It may also arise from the parieto-occipital artery or posterior temporal branches. It courses deep in the fissure, giving branches both to th...
The calcarine fissure, or calcarine sulcus, is located on the medial surface of the occipital lobe and divides the visual cortex (a.k.a. calcarine cortex) into two.
The fissure is variable in course (figure 1), but is generally oriented horizontally, anteriorly joining the parieto-occipital fi...
Calcification of the globe has many causes, varying from the benign to malignant. When calcification is seen of the posterior half of the globe, it could relate to any of the layers (scleral, choroidal or retinal), as it is not possible to separate them out on CT.
drusen: 1% population...
Calcified cerebral embolus is an uncommon and often overlooked cause of embolic ischaemic stroke.
Although emboli are a common cause of ischaemic stroke, calcified cerebral emboli are considered rare. With only a paucity of literature regarding calcified cerebral emboli – only 48...
Calcified chronic subdural haematomas are rare variants of chronic subdural haematomas.
Calcified chronic subdural haematomas are uncommon, accounting for only 0.3-2.7% of chronic subdural haematomas 1-3. They are seen more commonly in children than in adults 1-3.
Calcifying pseudoneoplasms of the neuraxis (CAPNON) are rare non-neoplastic, non-inflammatory heavily calcified discrete intraparenchymal or extra-axial lesions of CNS. The most common location is temporal region.
They usually asymptomatic and found incidentally but somet...
The callosal angle has been proposed as a useful marker of patients with idiopathic normal pressure hydrocephalus (iNPH), helpful in distinguishing these patients from those with ex-vacuo ventriculomegaly (see hydrocephalus versus atrophy).
Ideally the angle should be measured on a cor...
The callosal sulcus is a sulcus of the brain, located on the medial side of each cerebral hemisphere, deep within the medial longitudinal fissure.
The callosal sulcus runs posteriorly from the genu to the splenium of the corpus callosum. It separates the cingulate gyrus dorsally...
The callosomarginal artery (also known as median artery of corpus callosum) is the largest branch of the pericallosal artery. It runs in or posteriorly to the cingulate sulcus and runs a course parallel to the pericallosal artery where it divide to give two or more cortical branches to supply th...
The callososeptal interface is located on the inferior surface of the corpus callosum, when the septum pellucidum abuts it.
It came to radiological attention when T2 hyperintense lesions affecting this region were believed to be specific for multiple sclerosis. This has, as is usually the case...
Calvarial thickening can occur from a number of causes. These include:
chronic ventricular shunting1
anaemias (largely associated with massive haematopoiesis)
The Canadian CT head rule (CCTHR) is a validated clinical decision rule to determine the need for CT head in adult emergency department patients with minor head injuries.
Patient has suffered minor head trauma with resultant:
loss of consciousness
Canavan disease, also known as spongiform degeneration of white matter (not to be confused with Creutzfeldt-Jakob Disease) or aspartoacylase deficiency, is a leukodystrophy clinically characterised by megalencephaly, severe mental and neurological deficits, and blindness.
Capillary haemangiomas of the orbit, also known as strawberry haemangiomas, on account of its colouring, or orbital infantile haemangiomas, are the most common orbital tumours of infancy, and unlike orbital cavernous haemangiomas, they are neoplasms rather than vascular malformations.
The caput medusae sign, refers to developmental venous anomalies of the brain, where a number of veins drain centrally towards a single drain vein. The appearance is reminiscent of Medusa, a gorgon of Greek mythology, who was encountered and defeated by Perseus.
The sign is seen on both CT and ...
Caput succedaneum is a manifestation of birth trauma, and it consists of a subcutaneous serosanguineous fluid collection beneath the newborn's scalp. The fluid collection is extra-periosteal. It may be imaged with ultrasound, CT, or MRI.
Caput succedaneum results from pressure on the presenting...
Cerebral autosomal recessive arteriopathy with subcortical infarcts and leukoencephalopathy (CARASIL) is a systemic genetic disorder affecting the cerebral small vessels, spine and hair follicles.
It should not be confused with its autosomal dominant counterpart, CADASIL. Autosomal recessive i...
Carbon monoxide (CO) poisoning may result in an anoxic-ischaemic encephalopathy, with acute as well as delayed effects.
CO poisoning is mostly preventable with common causes including malfunctioning heating systems, improperly ventilated motor vehicles, and residential fires 9. It...
Caroticocavernous fistulas (CCF) represent abnormal communication between the carotid circulation and the cavernous sinus. They can be classified as direct or indirect which are separate conditions with different aetiologies.
Direct CCFs are often secondary to trauma, and as suc...
The caroticotympanic branch (tympanic branch) is a small branch from the C2 segment of the internal carotid artery. It is a vestigial remnant of the hyoid artery.
It passes posterolaterally into the middle ear cavity and anastomoses with the inferior tympanic artery (a branch of the external ca...
Carotid artery stenosis also referred as extracranial carotid artery stenosis, is usually caused by an atherosclerotic process and is one of the major causes of stroke and transient ischemic attack (TIA) 1.
This article refers to stenosis involving carotid bulb and the proximal segment of inte...
The carotid cave is a potential dural space formed by the redundant distal dural ring on the medial aspect of the clinoid segment of the internal carotid artery (ICA). It has been reported to be present in ~80% of cadaveric specimens 3.
The clinoid segment of the ICA is bounded b...
Cartilaginous meningiomas are extremely rare histological variants of meningiomas grouped into the subtype of metaplastic meningiomas, being WHO grade I tumours. They are characterised by the cartilaginous transformation observed within the tumour.
Although reported numbers are too small to con...
The cases featured in these video lectures are specifically selected to teach important concepts in radiology over a broad range of topics. The tutorials vary in difficulty from basic to advanced. For maximum learning, try the cases for yourself in Radiopaedia quiz mode first.
We love this ser...
Cataract is an opacification or thickening of the lens within the globe and is the leading cause of blindness in the world 2.
Visual deterioration occurs with increasing degrees of severity. The diagnosis is made clinically.
Common causes include:
The cauda equina is the collective term given to nerve roots distal to the conus medullaris, which occupy the lumbar cistern.
It's name comes from the Latin for "horse's tail".
Cauda equina syndrome refers to a collection of symptoms and signs that result from severe compression of the descending lumbar and sacral nerve roots. It is considered a diagnostic and surgical emergency.
Cauda equina syndrome is rare with prevalence estimated at approximately 1...
Caudal epidural injections, or sacral hiatus epidural injections, are one of several possible spinal epidural injections.
Typically, epidural injections are performed in patients who are currently not surgical candidates. The caudal injection can be performed when patients are on ...
Caudal regression syndrome (CRS) represents a spectrum of structural defects of the caudal region. Malformations vary from isolated partial agenesis of the coccyx to lumbosacral agenesis.
Caudal regression syndrome is rare, with an estimated incidence of 1:7500-100,000 7,10.
Caudate nuclei are paired nuclei which along with the globus pallidus and putamen are referred to as the corpus striatum, and collectively make up the basal ganglia. The caudate nuclei have both motor and behavioural functions, in particular maintaining body and limb posture, as well as controll...
The caudothalamic groove is an important landmark when performing neonatal cranial ultrasound.
As the name suggests, it is located between the caudate nucleus and thalamus, and is a shallow groove projecting from the floor of the lateral ventricle. It is approximately at the leve...
A mnemonic to help recall some of the causes of acute confusion in the elderly include:
How Come 'Dis DoDo Is Excited
D: drug effects
E: electrolyte imbalance
The causes of dementia can be remembered using the mnemonic:
V: vitamin deficiency: B1, B6, B12, folate
A: autoimmune: cerebral vasculitis, systemic lupus erythematosus
N: normal pressure hydrocephalus, neoplasia
I: infection: Creutzfeldt-Jakob disease, herpes simplex enc...
The cavernous sinuses are paired dural venous sinuses.
The cavernous sinus (CS) is located on either side of the pituitary fossa and body of the sphenoid bone between the endosteal and meningeal layers of the dura. It spans from the apex of the orbit to the apex of the petrous t...
The structures inside and beside the cavernous sinus and their relative positions can be recalled with the following mnemonic:
O TOM CAT
Consider a coronal view of the cavernous sinus.
'O TOM' are the first letters of components of the lateral wall of cavernous sinus considered vertically, fr...
Cavernous sinus haemangioma is an uncommon cause of a cavernous sinus mass. Preoperative diagnosis is important to avoid unexpected surgical blood loss.
Cavernous haemangiomas of the cavernous sinus account for less than 1% of all parasellar masses 1. They have a predilection for...
A cavernous sinus mass has a wide differential including:
orbital apical inflammation with cavernous sinus involvement (Tolosa-Hunt syndrome)
any of the cranial nerves traversing the cavernous sinus: III, IV, V (V1 and V2) and VI
trigeminal schwannoma is ...
Cavernous sinus thrombosis (CST) is a rare condition, most commonly infectious in nature, and the diagnosis on imaging is not always straightforward. It has high mortality and morbidity rates.
CST is rare with ~4.5 cases per 1,000,000 per year 5. It is the least common dural venou...
Cavernous venous malformation, also traditionally referred to as a cavernous haemangioma (despite it not being a tumour) or cavernomas, are non-neoplastic slow flow venous malformations found in many parts of the body.
Despite the ubiquity of use of the traditional terms cavernoma...
Cavum septum pellucidum (CSP), or more grammatically correct cavum septi pellucidi, is a normal variant CSF space between the leaflets of the septum pellucidum.
It is sometimes called the fifth ventricle, but this term is not in current use as a CSP does not have any direct communi...
A cavum veli interpositi (CVI) is a normal variation where there is a dilated CSF space involving the velum interpositum. When larger than 1 cm in axial transverse measurement, with outwardly bowed margins and positive mass effect, the term cyst of the velum interpositum or cavum veli interposit...