NEURORADIOLOGY SIGN 1

I love learning new radiology signs, and love overall those ones so funny and effective that once you learned'em, you'll never forget'em. Once in a while I will present a neuroradiology sign. Remember that a every months on Radiology journal, there is a column "signs in radiology" but of course a neuroradiology one comes not more than twice a year.



THE MOTHER-IN-LAW EFFECT


Derek Harwood Nash, one of the pioneers of neuroradiology, wanted to find an easy way to describe the DSA (digital subtraction angiography) behaviour of meningioma. He noticed that the tumour blush in a meningioma comes very early (early wash-in); normally it is very dense and persistent with a delayed wash-out. This reminded him the behaviour of an unwanted guest who comes early and stays late, and the guest that classically do this is actually the mother-in-law. Meningioma has both a dural and a pial blood supply and a sunburst or radial appearance of the feeding arteries. Depending on the location you may have to perform internal carotid, external carotid, ab vertebral injections. In the typical sphenoid wing meninigioma, the middle menigneal artery is enlarged.



Here is a nice recent review about angiography and meningioma

Dowd CF, Halbach VV, Higashida RT.
Meningiomas: the role of preoperative angiography and embolization.Neurosurg Focus. 2003 Jul 15;15(1):E10. Review.



Here is a link to see the mother in law effect

Famous faces-facies and disease - 7th episode

Due to the great number of requests, "Famous faces-facies and disease" returns with the 7th episode.

Actor, american.

Diagnosis please

ANSWER:

Diagnosis is achondroplasia.

Achondroplasia is an autosomal dominant genetic disorder, common cause of dwarfism. The average adult height is 131 cm for males and 123 cm for females. The prevalence is approximately 1 in 25,000.

Achondroplasia is a result of an autosomal dominant mutation in the fibroblast growth factor receptor gene 3 (FGFR3), which causes an abnormality of cartilage formation. FGFR3 normally has a negative regulatory effect on bone growth. In achondroplasia, the mutated form of the receptor is constitutively active and this leads to severely shortened bones.

In this case you could diagnose it by the typical facies.

Main charachteristics of "achondroplasic facies" are a strong disproportion between the splanchnocranium and neurocranium, a protruding and convex forehead, and a short-stocky nose.

He is Peter Dinklage, an American actor born in 1969. He participated in many movies/series, among which I remind The Station Agent and episodes of Nip/Tuck. His height is 1.35 m. When he was asked about his disease, he said:

"When I was younger, definitely, I let it get to me. As an adolescent, I was bitter and angry and I definitely put up these walls. But the older you get, you realize you just have to have a sense of humor. You just know that it's not your problem. It's theirs."

At present, there is no treatment for achondroplasia.

Previous episodes:
1 - Vincent Schiavelli - Marfan disease
2 - Maggie Smith - Graves disease
3 - Dan Aykroyd - Heterochromia
4 - Mikhail Sergeyevich Gorbachev - Port-wine stain
5 - Alexander Chapman Ferguson - Rosacea
6 - Kirk Douglas and his son, Michael Douglas - Dimple chin

Can you find central sulcus?

Many times in my MRI and CT reports, I happen to decide whether to ascribe a lesion to frontal or parietal lobe. The most interesting source to comprehend the way to find the central sulcus and hence understand where is frontal brain and where is parietal brain, is Weissleder's "Primer of diagnostic imaging" 4th edition. It enumerates on page 500 seven different ways to do so.

Here them are: (CS= Central Sulcus)

1. SUPERIOR FRONTAL SULCUS/PRE-CS SIGN: the posterior end of the superior frontal sulcus joins the pre-CS



2. SIGMOIDAL HOOK SIGN: hooklike configuration of the central sulcus corresponding to the motor hand area



3. BIFID POST-CS SIGN: medial part of post-CS appears bifid



4. INTRAPARIETAL SULCUS INTERSECTS THE POST-CS: the anterior end of the intraparietal sulcus joins the post-CS



5. MIDLINE SULCUS SIGN: most prominent convexity sulcus that reaches the midline in the CS



6. PARS BRACKET SIGN: paired pars marginalis at or behind the CS



7. THIN POST-CENTRAL GYRUS SIGN: post-central gyrus appear thinner than precentral gyrus

According to Grossman and Yousem's Neuroradiology the Requisites, "sometimes finding the central sulcus can be a bear" and these are their seven rules (from 1 to 4 are the same as weissleder 1 to 4, just expressed differently):

1. The superior frontal sulcus terminates in the precentral sulcus and the central sulcus is the next sulcus posterior to the precentral sulcus.



2. The knob representing the hand motor area is in the precentral gyrus.



3. The medial end of the post-central sulcus is shaped like a bifid "y" and the bifid ends enclose the marginal ramus of the cngulate sulcus.



4. The intraparietal sulcus intersects the postcentral sulcus.



5. The central sulcus enters the paracentral lobule anterior to the marginal ramus of the cingulate sulcus.



6. The precentral gyrus cortical gray matters thickness is greater than that of the postcentral gyrus thickness. Usually pre/post thickness ratio is about 1.5/1.



7. The pre-rolandic cortex is more hypointense than surrounding cortex on FLAIR.

Radiologists connections

If you are a radiologist go and check this new site radRounds .

It looks similar to a Facebook counterpart for radiologists with the aim of connecting them all over the world.

Interesting.

Thanks Sumer Sethy for the info.

A woman died because of a radiologist error

Incredible what happened in Bologna, Italy. Read here. If you know italian and want to read more, you can find many other sources going to googlenews and writing bologna + tac.

A healthy woman had her CT report and images swapped with those pertaining to another patient with the same surname and with a kidney mass to be asported.

The surgeon, reading the report and images decided for surgery.

So, the healthy woman underwent kidney surgery and eventually died becaus of some surgical problems in that operation.

I ask myself:

• Isn' it strange that the first time we hear of such a thing, the patient dies?
• Is it possible that this is a common error, but, until there are no deaths, nobody speak about it?

VIAGRA from VIgorous + niAGaRA...

I've been always fascinated by the origin of medical words. Above all because it can be a good way to remember some concept that stays behind that word and thus create some mind maps.

Anatomy words etimology was my passion in the firts years of medical school.
For example do you know why, in the case of the the liver, the object (liver) and the adjective derived from it (hepatic) are different?

Pathology words etymology was my passion over the last years of medical school.
For example do you know the origin of the word aneurysm or of the word teleangectasis?

Now that I am a Medical Doctor using and prescribing drugs, my passion is to understand the origin of the brand name of drugs. It is a very interesting field because, as you can easily understand, the name of the drug can make the difference whether a drug becomes a blockbuster or not.
For example do you know why Viagra is called like that? "the prefix "vi" to suggest vigor and vitality. The word rhymes with Niagara, suggesting a mighty flow." as said in this article by John Russell.
Why are there so many "x" or "z" in the names of the drugs? because they reminds us concept of high-tech , making us to think those drugs are newer...

It goes obvious that my favourite brand names are those in which is intrinsic the scientific name of the drug, for example TENOrmin for aTENOlol, HALDOL for HALoperiDOL, MEPRAL for oMEPRAzoL.

But the best is reached when, by reading the brand name you can remind both the scientific name and its mechanism of action, e.g. ALDACTONE, which reminds spironoLACTONE and ALDosterONE.

REFERENCES:

• Article on medscape
• Article by John Russell
• Lambert BL, Chang KY, Lin SJ. Descriptive analysis of the drug name lexicon. Drug Inf J. 2001;35:163-72.
• Gundersen L. The complex process of naming drugs. Ann Intern Med. 1998;129:677-8.
• Kirkwood J. What's in a name? Available at www.igorinternational.com. Accessed October 31, 2003.
• Gertsel J. What's in a name? Elevated drug sales. Toronto Star. 2003(Aug 22). Available at http://www.thestar.com. Accessed December 20,2003.

The puppy sign!

On last number of the green journal (JNNP), one of the journals to be checked regularly by neuroradiologists, there is a very curious new described sign: The puppy sign!

This is my puppy, his name is Filippo...and I will no more look in his eyes at the same way as I did previously