Extensive CEREBRAL VENOUS SINUS THROMBOSIS with COLLATERAL formation


35-year old gentleman presented with episodes of headache for the past two weeks. There were no other significant past history. CT brain showed features of 1. Right transverse sinus thrombosis (red arrow), 2. Internal cerebral veins thrombosis (thin yellow arrow), 3. Straight sinus thrombosis (orange arrow), 4. Superior sagittal sinus thrombosis (thick yellow arrow) MRContinue reading “Extensive CEREBRAL VENOUS SINUS THROMBOSIS with COLLATERAL formation”

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”

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”

Hypertension is a Risk Factor for Both Ischemic Stroke and Hemorrhagic Stroke


Hypertension is a risk factor for both ischemic as well as hemorrhagic strokes. In the case presented here, same patient suffered ischemic and hemorrhagic strokes at two different times. On the CT scan image above, yellow arrows point to the old left temporal infarct. Red arrows point to an acute right thalamic hemorrhage. Control ofContinue reading “Hypertension is a Risk Factor for Both Ischemic Stroke and Hemorrhagic Stroke”

Rapid Expansion of Hypertensive INTRACEREBRAL HEMATOMA


54-year old lady presented with left-sided hemiparesis and drowsiness of 6 hours duration. Her BP at admission was 220/160 mmHg. She was started on anti-hypertensive medications. After 11 hours, her clinical condition worsened and she became comatose. Anisocoria was also noted. BP was 160/100 mmHg. CT scan of brain was repeated, which showed massive increaseContinue reading “Rapid Expansion of Hypertensive INTRACEREBRAL HEMATOMA”

POSTERIOR REVERSIBLE ENCEPHALOPATHY syndrome


17 year old girl presented with acute onset history of headache, blurring of vision and seizures. She was a known case of chronic kidney disease, and was awaiting a kidney transplant. Her BP at persentation was 200/140 mmHg. CT brain done showed bilateral parieto-occipital hypodensities. A diagnosis of posterior reversible encephalopathy syndrome (PRES) was made.Continue reading “POSTERIOR REVERSIBLE ENCEPHALOPATHY syndrome”

POST-TRAUMATIC RIGHT FRONTAL CONTUSION


This is the CT scan of a 24-year old person man who met with a road-traffic accident. He was riding a two-wheeler, without wearing helmet. CT scan shows right frontal contusion, with mass effect. There is fracture of overlying frontal bone. Treatment is conservative in the initial stage with anti-cerebral edema measures and anti-epileptic drugs.Continue reading “POST-TRAUMATIC RIGHT FRONTAL CONTUSION”

Acute Hydrocephalus Developing After Pontine Hemorrhage


Pontine haemorrhages are uncommon and account for about 10% of all cases of intracerebral hemorrhage (ICH). Hypertension is the most common underlying cause, accounting for about 90% of all cases. Pontine hemorrhages are associated with high morbidity and mortality. About 40% people with pontine bleeds do not survive. Low GCS at admission and hemorrhage volumeContinue reading “Acute Hydrocephalus Developing After Pontine Hemorrhage”

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”