Teaching NeuroImages: Reverberating TCD flow pattern in brain death

Teaching NeuroImages: Acute tetraparesis: Mind the brain.

A 65-year-old woman presented with acute tetraparesis. Neurologic examination showed severe leg paresis and mild proximal arm weakness, bilateral extensor plantar responses, hyperreflexia, and abulia. Brain MRI showed bilateral anterior cerebral artery (ACA) territory infarctions (figure). On evaluation, she had patent foramen ovale, deep venous thrombosis, and bilateral moderate carotid artery...

Teaching NeuroImages: neurodegeneration with brain iron accumulation in aceruloplasminemia.

A 55-year-old African Canadian man with insulin-dependent diabetes mellitus and alcohol abuse presented with diabetic ketoacidosis. Progressive cognitive decline over the previous 5 years resulted in long-term care placement. Aside from pigmentary retinopathy, general examination was unremarkable. MRI demonstrated iron accumulation in the brain (figure 1) and liver (figure 2A). Ceruloplasmin, a...

Teaching neuroimages: fungus in the brain: coccidioidomycosis meningoencephalitis.

Teaching NeuroImages: Severe vasospasm in traumatic brain injury.

A 45-year-old man had a severe traumatic brain injury (TBI) withmulticompartmental hemorrhages (figure 1). He was initially noted to be awake and following commands with his right side. Two weeks later, his examination deteriorated to coma with flaccid quadriplegia. Initial workup, including EEG, was unrevealing. MRI brain showed new multiterritorial infarcts (figure 1); a catheter-based angiog...

Teaching neuroimages: onion-skin pattern facial sensory loss.

A 42-year-old woman presented with acute-onset facial numbness. Physical examination revealed graded loss of pain and temperature over the left half of her face with central sparing (figure 1A)—an onion-skin distribution. Corneal reflex was sluggish on the left, but results for the rest of the clinical examination, CSF studies, and visual evoked potential were normal. MRI was suggestive of acut...