Subdural Hematoma Developing after VP Shunt Surgery for Normal Pressure Hydrocephalus


Normal pressure hydrocephalus (NPH) consists of Hakim-Adams triad: Gait disturbances, memory decline and urinary incontinence. Ventriculo-peritoneal shunt (VP shunt) is routinely recommended to treat this condition. Acute or subacute subdural hematoma (SDH) can occur in 2-17% of patients following VP shunt. Increased susceptibility to SDH can be attributed to the shunt decreasing intracranial pressure byContinue reading “Subdural Hematoma Developing after VP Shunt Surgery for Normal Pressure Hydrocephalus”

Hemifacial Spasm caused by a Dolicho-ectatic Basilar Artery


An otherwise healthy man presented with left hemifacial spasm of 3 years duration. It started with left blepharospasm (involuntary contractions of eyelid muscles) causing narrowing of palpebral aperture. Gradually, the symptoms progressed to involve the left side of face. Involuntary contractions occurred in muscles of facial expression and lip muscles also. MRI with MR AngiogramContinue reading “Hemifacial Spasm caused by a Dolicho-ectatic Basilar Artery”

Large CP Angle tumor Presenting with Long-standing Deafness


40-year old gentleman presented with left-sided hearing loss, which slowly deteriorated over time. At the time of presentation, he was completely deaf. Other symptoms included mild dizziness and imbalance. On examination, he had left-sided sensori-neural hearing loss. Tandem gait was impaired. He had consulted several ENT doctors over the past 4 years, and he wasContinue reading “Large CP Angle tumor Presenting with Long-standing Deafness”

MRI Abnormalities in Canavan’s Disease- Leukodystrophy


9 month old child was brought with a history of developmental delay (both motor and speech delay) and seizures. The symptoms were progressively worsening. There was no family history of similar illness. On examination, the child had large head (macrocephaly) and spasticity of all 4 limbs. MRI brain showed megalencephalic appearance with symmetric increased signalContinue reading “MRI Abnormalities in Canavan’s Disease- Leukodystrophy”

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”

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