Acute Subdural Hematoma mimicking a stroke


87-year old gentleman was brought to OPD with complaints of right-sided weakness and inability to speak of 48-hours duration. He was apparently well prior to that. He had earlier been treated for cardiac disease, however, details were not known. There was no history of head trauma. On examination, he was conscious, however, had global aphasia.Continue reading “Acute Subdural Hematoma mimicking a stroke”

Subdural Hematoma (SDH) Leading to Rapid Deterioration in a Patient with Alzheimer’s Disease


70-year old man was brought with a history of progressive cognitive impairment of one year duration. However, there was a rapid deterioration of symptoms for the past few weeks. CT brain showed right sided subacute to chronic subdural hematoma (SDH). In addition, CT brain also showed cerebral atrophy on the left side. PET scan wasContinue reading “Subdural Hematoma (SDH) Leading to Rapid Deterioration in a Patient with Alzheimer’s Disease”

“HOT CROSS BUN” Sign


Hot cross bun sign is typically seen in patients with multiple system atrophy (MSA). This refers to cruciform hyperintensity seen in pons (as seen in the left side FLAIR MRI image). The sign is due to selective loss of myelinated transverse pontocerebellar fibres and neurons in the pontine raphe, with preservation of the pontine tegmentumContinue reading ““HOT CROSS BUN” Sign”

Classical MRI BRAIN Finding in Hyperosmolar Hyperglycemic State


Hyperosmolar hyperglycemic state (HHS), also known as nonketotic hyperglycemia (NKH) occurs in a poorly controlled diabetic. HHS is characterised by high blood sugars (usually more than 600 mg%), increased serum osmolarity and profound dehydration. 80-year old lady presented with acute onset altered sensorium and involuntary choreiform movements affecting the left upper and lower limbs. ThereContinue reading “Classical MRI BRAIN Finding in Hyperosmolar Hyperglycemic State”

Conjugate Eye Deviation in Capsulo-Ganglionic Bleed


49-year old man presented with right-sided weakness of six hours duration. He was hypertensive and his BP at admission to ER was 200/120 mmHg. He had conjugate eye deviation (CED) to the left side and right sided horizontal gaze paresis. He had right hemiplegia with grade 0/5 power in right upper and lower limbs. NoncontrastContinue reading “Conjugate Eye Deviation in Capsulo-Ganglionic Bleed”

Conjugate Eye Deviation and Horizontal Gaze Paresis due to Pontine Bleed


65-year old man presented with acute onset right-sided numbness and deviation of eyes to the right side. He was unable to look to the left, suggestive of left-sided horizontal gaze paresis. CT Brain revealed a hemorrhage (bleed) in the left side of pons (dorso-medial region). The clinical findings can be explained by damage to theContinue reading “Conjugate Eye Deviation and Horizontal Gaze Paresis due to Pontine Bleed”

Horizontal Gaze Paresis Due to Pontine Infarct


60 year old lady presented with blurring of vision of 6 hours duration. Clinical examination revealed left-sided horizontal gaze paresis. She had no other focal neurological deficits. MRI Brain showed acute infarct (hyperintense signals on DW images, as shown above) in the left side of pons, affecting its dorso-medial part. Horizontal gaze paresis in pontineContinue reading “Horizontal Gaze Paresis Due to Pontine Infarct”

Carpopedal Spasm due to Hypocalcemic Tetany


22-year old lady was noted to have painful cramps and spasms affecting both hands. Her calcium level was found to be 7.2 mg/dl (normal: 9-10.5 mg/dl). Pictures of her hands are shown above. A diagnosis of hypocalcemic tetany was made. In carpopedal spasm, both hands and feet are affected. In hands, there is flexion atContinue reading “Carpopedal Spasm due to Hypocalcemic Tetany”

Eschar: A clue to the Diagnosis of Scrub Typhus


Scrub typhus is among the common causes of febrile illnesses, noted globally. It should be included in the differential diagnosis of febrile illness along with more common conditions such as malaria, typhoid, leptospirosis, etc. In addition to fever, patients with scrub typhus may have headache, skin rash, joint pains, lymphadenopathy and an eschar. Eschar isContinue reading “Eschar: A clue to the Diagnosis of Scrub Typhus”

White Matter Hyperintensity on MRI in Migraine


White matter hyperintensities (WMH) on MRI (T2W and FLAIR sequences) are seen in several conditions. The most common among them (from more common to less common) are: 1. Migraine, 2. Small vessel ischemia, 3. Multiple sclerosis Here you can see a FLAIR MRI image showing periventricular hyperintense lesions (right more than left) in a 25-yearContinue reading “White Matter Hyperintensity on MRI in Migraine”