Mechanical Thrombectomy in Wake-Up Stroke


Mechanical thrombectomy is very effective in the first few hours after onset of symptoms, in patients with acute ischemic stroke. It is approved within the first six hours of symptom onset, if there is occlusion of internal carotid artery or proximal middle cerebral artery, provided the NIHSS score is 6 or more. However, problem arisesContinue reading “Mechanical Thrombectomy in Wake-Up Stroke”

Excellent Response to Medical Treatment in a Case of Brain Tuberculoma


Tuberculous infection of the brain is quite common. TB can affect brain and spine in a number of ways- tuberculous meningitis, tuberculoma, brain abscess, Pott’s spine, etc. Brain tuberculoma are commonly seen in India. The patients with tuberculoma of brain present with seizures and focal neurological deficits. Here, I am presenting a 35-year old manContinue reading “Excellent Response to Medical Treatment in a Case of Brain Tuberculoma”

SWI (GRE) Sequences are the BEST to Detect Bleed on MRI Brain


It is extremely vital that we differentiate brain hemorrhage (bleeding) from brain infarcts, when patients present with clinical features of stroke. This is because patients with infarcts are eligible to receive thrombolytic treatment, to lyse the blood clots. On the other hand, thrombolytic treatment is contraindicated in patients with brain hemorrhage (bleed). Drugs used forContinue reading “SWI (GRE) Sequences are the BEST to Detect Bleed on MRI Brain”

Predictors of Poor Outcome in Thalamic Hematoma


Thalamic hematomas form the second largest group of spontaneous intracerebral hemorrhage (ICH), which are related to hypertension. Outcome depends on several factors including age, size of hematoma, GCS score and CT scan findings. Factors predicting poor outcome in a patient with thalamic hematoma are: Male sex Low GCS (<8) Older age Uncontrolled high BP especiallyContinue reading “Predictors of Poor Outcome in Thalamic Hematoma”

Expansion of Thalamic Hemorrhage After Initial Presentation


Intracerebral hemorrhage (ICH) accounts for 20-35% of all strokes. Hypertension is the commonest underlying cause of ICH. The common sites for hypertensive ICH are putamen, thalamus, pons, cerebellum, subcortical and lobar hematomas. Basal ganglia (putamen) is the most common site for ICH accounting for about 50% of all cases. Thalamus holds the second position andContinue reading “Expansion of Thalamic Hemorrhage After Initial Presentation”

Ptosis due to Extraocular Muscle Swelling


60-year old gentleman presented with 5-day history of left sided ptosis and proptosis. He had conjunctival congestion. He was a diabetic, however, he had no history of thyroid disease. MRI brain showed swelling of left superior rectus, levator palpebrae superioris and lateral rectus muscles on the left side. Differential diagnosis include: Thyroid eye disease, idiopathicContinue reading “Ptosis due to Extraocular Muscle Swelling”

Dysembryoplastic Neuroepithelial Tumor (DNET) causing Refractory Focal Seizures


Dysembryoplastic neuroepithelial tumor (DNET) is relatively uncommon benign tumor, responsible for causing partial seizures in children, many of those cases may be medically refractory. The most common location is temporal lobe, as in this case (about 65% of cases). About 20% cases involve frontal lobe. The remainder of cases involve caudate nucleus, cerebellum and pons.Continue reading “Dysembryoplastic Neuroepithelial Tumor (DNET) causing Refractory Focal Seizures”

Subependymal Calcification Demonstrated on SWI MRI in a Case of Tuberous Sclerosis


Tuberous sclerosis is a multi-systemic genetic disease, which predominantly manifests with seizures and cutaneous manifestations (such as adenoma sebaceum). Abnormalities on brain scan include cortical tubers, subependymal nodules (sually calcified) and subependymal giant cell astrocytoma (SEGA). MRI is usually preferred over CT scan as tubers and SEGAs are better appreciated on MRI as compared toContinue reading “Subependymal Calcification Demonstrated on SWI MRI in a Case of Tuberous Sclerosis”

Hyperdense MCA sign in Acute Ischemic Stroke


55-year old gentleman, known diabetic and hypertensive presented with symptoms of right hemiplegia and aphasia of three hours duration. He was evaluated for possible thrombolytic treatment. CT brain done (3.5 hours after stroke symptom onset) showed a dense (also referred to as hyperdense) MCA sign (yellow arrow in the 1st image). Thrombosis of middle cerebralContinue reading “Hyperdense MCA sign in Acute Ischemic Stroke”

CAVERNOMA Causing Chronic Focal Epilepsy


FLAIR MRI images shows a left frontal hypointense lesion with multiple flow voids, surrounded by hyperintense areas, suggestive of a cavernoma with surrounding gliosis. The patient had a history of right focal motor seizures (with or without secondary generalization) of 5 years duration, which was well controlled with medications (oxcarbazepine, sodium valproate and clobazam). Therefore,Continue reading “CAVERNOMA Causing Chronic Focal Epilepsy”