Teaching NeuroImages: Unmasking raccoon eyes: A classic clinical sign

Raccoon Eyes

A 31-year-old male presented to the emergency department with a chief complaint of headache after being assaulted with a baseball bat to the head. He denied loss of consciousness, nausea or vomiting. Past medical and surgical history was unremarkable. On physical examination, vitals signs included elevated blood pressure (167/92 mm Hg) and tachycardia (132 bpm). He was somnolent but easily arou...

Teaching neuroimages: MRI "target sign" and neurofibromatosis type 1.

A 9-year-old girl presented with a firm occipital swelling. She had multiple café-au-lait lesions without other clinical features or family history of neurofibromatosis type 1 (NF1). MRI showed subcutaneous soft tissue mass in the left occipitotemporal region with “target sign” suggestive of plexiform neurofibroma (figure 1). There were supra and infratentorial T2-weighted hyperintense lesions,...

Teaching NeuroImages: Spontaneous spinal epidural hematoma with spot sign positivity.

Teaching NeuroImages: Gasperini syndrome.

Gasperini syndrome is a rare crossed brainstem syndrome characterized by ipsilateral impairment of the VI, VII, and occasionally VIII cranial nerves and contralateral sensory loss. The syndrome, initially described by Ubaldo Gasperini in 1912, results from a lesion of the caudal pons tegmentum (figure e-1, links.lww.com/WNL/A47). The most frequent cause is the occlusion of the long circumferent...

Teaching NeuroImages: chordoma.

A 30-year-old man presented with recurrent headaches. CT head revealed a clival chordoma (figure 1A). Chordomas originate from the embryonic remnants of the notochord and account for 2%–4% of all malignant bone tumors. They have a predilection for the axial skeleton, with 35% affecting the spheno-occipital region. The incidence peaks at ages 20–40 years. Male patients are affected twice Figure ...