Atlas of the Human Brain and Spinal Cord, 2nd Edition

Section 4 - Case Studies of Brain Tumors and Degenerative Disease of the CNS

 

CASE 1 Astrocytoma grade II, coronal, T1

Four-year-old boy presenting with seizures. Arrows point to amorphous thickening of the cortical gray. Patients show little pleomorphism, no nuclear endothelial proliferation, and no necrosis; they survive 10 to 15 years after surgery.

This photo was published in Magnetic Resonance Imaging of CNS Disease: A Teaching File, 2nd edition, D. H. Yock, Jr., 2002, page 46, Case 72. Copyright Elsevier, 2002. Used by permission.

CASE 2 Cystic cerebellar astrocytomas, sagittal, T1

Four-year-old girl presenting with clumsiness and headaches. Gliomas of the cerebellum are among the most frequent posterior fossa tumors; these tumors are benign. Arrow points to tumor nodule at margin of cyst.

This photo was published in Magnetic Resonance Imaging of CNS Disease: A Teaching File, 2nd edition, D. H. Yock, Jr., 2002, page 88, Case 142. Copyright Elsevier, 2002. Used by permission.

 

CASE 3 Glioblastoma multiforme, axial, T2

Sixty-two-year-old woman presents with headaches and a left hemiparesis; the most common glial tumor. Papilledema and herniation are seen. Tumor cells across the corpus callosum resulting in a “butterfly” glioma. Histology includes: increased cellularity, hemorrhagic zones, pseudopalisades, vascular endothelial proliferations, and cysts. Glioblastomas are malignant, rapidly fatal, astrocytic neoplasms. Survival time is 6 to 9 months.

This photo was published in Magnetic Resonance Imaging of CNS Disease: A Teaching File, 2nd edition, D. H. Yock, Jr., 2002, page 63, Case 104. Copyright Elsevier, 2002. Used by permission.

CASE 4 Oligodendroglioma, axial, T2

Fifty-three-year-old woman presents with headache. Oligodendrocytes show calcification and hemorrhage, more so than astrocytomas. An oligodendroglioma may become a malignant glioblastoma.

This photo was published in Magnetic Resonance Imaging of CNS Disease: A Teaching File, 2nd edition, D. H. Yock, Jr., 2002, page 69, Case 116. Copyright Elsevier, 2002. Used by permission.

 

CASE 5 Malignant ependyoma, axial, T2

Two-year-old girl presenting with nausea and vomiting; large “flow voids” show a highly vascular lesion. Periventricular edema is seen along the border of the hydrocephalic right lateral ventricle. Malignant ependyoma is found in the fourth ventricle more frequently than in the lateral ventricles.

This photo was published in Magnetic Resonance Imaging of CNS Disease: A Teaching File, 2nd edition, D. H. Yock, Jr., 2002, page 74, Case 124. Copyright Elsevier, 2002. Used by permission.

CASE 6 Meningioma (convexity) axial, T1

Forty-four-year-old woman presenting with signs of intracranial pressure (e.g., headaches). “Dural tails” are marked with white arrows; this tumor shows slow growth and is not invasive. Meningiomas account for 20% of primary intracranial tumors; they are ubiquitous and arise wherever arachnoid cells are present, and they are predominantly found in women. Histology: concentric whorls and calcified psammoma bodies.

This photo was published in Magnetic Resonance Imaging of CNS Disease: A Teaching File, 2nd edition, D. H. Yock, Jr., 2002, page 30, Case 50. Copyright Elsevier, 2002. Used by permission.

 

CASE 7 Acoustic schwannoma (neurilemmoma or neurinoma), axial, T1

Thirty-eight-year-old woman with ipsilateral hearing loss, tinnitus and cerebellar ataxia: white arrows show expanded internal auditary meatus; black arrows show cisternal widening; cranial nerves involved are: CNN, VII, VIII, and the spinotrigemial tract. (in lateral pons). Histology: included are Antoni Type I and Antoni Type II tissue, and Verocay bodies.

This photo was published in Magnetic Resonance Imaging of CNS Disease: A Teaching File, 2nd edition, D. H. Yock, Jr., 2002, page 122, Case 195. Copyright Elsevier, 2002. Used by permission.

CASE 8 Meningioma, coronal, T1, mass in cerebellopontine angle

Thirty-eight-year-old woman presents with left facial pain. Tumor may involve cranial nerve near its entrance to the pons; the black arrow points to the normal CN, V1, V2, V3.

This photo was published in Magnetic Resonance Imaging of CNS Disease: A Teaching File, 2nd edition, D. H. Yock, Jr., 2002, page 123, Case 197. Copyright Elsevier, 2002. Used by permission.

 

CASE 9 Medulloblastoma, parasagittal, T1

Nine-year-old girl presents with ataxia, diplopia, and headaches. Differential diagnosis: astrocytoma, ependymoma, hemangioma, and choroid plexus papilloma; arise only in the cerebellum; represents 7% of primary common posterior fossa tumor in children; responsible for the posterior vermis syndrome; can metastasize via the CNF tracts; is highly radiosensitive.

This photo was published in Magnetic Resonance Imaging of CNS Disease: A Teaching File, 2nd edition, D. H. Yock, Jr., 2002, page 92, Case 150. Copyright Elsevier, 2002. Used by permission.

CASE 10 Pituitary adenoma, midsagittal, T1

Thirty-eight-year-old man presents with blurred vision. Arrow shows expanded sella turcica; the local mass effects include bone erosion, disruption of the diaphragma sellae, and compression of the optic chiasma, with bilateral hemianopsia, elevated intracranial pressure, headaches, seizures, obstructive hydrocephalus, and cranial nerve palsies, e.g., CN III, CN IV, and CN VI.

This photo was published in Magnetic Resonance Imaging of CNS Disease: A Teaching File, 2nd edition, D. H. Yock, Jr., 2002, page 144, Case 225. Copyright Elsevier, 2002. Used by permission.

 

CASE 11 Craniopharyngioma, sagittal, T1

Eight-year-old girl presents with headache and weight gain; ansomia with bitemporal hemianopia. Craniopharyngiomas compress chiasma and the third ventricle; most common of supratentorial tumors occurring in children; thought to be derived from Rathke's pouch (stomodeum). Tumors are cystic and contain a viscid yellow-brown fluid that is called “crank-case oil” and cholesterol crystals.

This photo was published in Magnetic Resonance Imaging of CNS Disease: A Teaching File, 2nd edition, D. H. Yock, Jr., 2002, page 158, Case 250. Copyright Elsevier, 2002. Used by permission.

CASE 12 Spinal cord ependymoma, sagittal, T2

Forty-seven-year-old woman presents with back and neck pain. Ependymomas are the most common intramedullary tumors of the spinal cord; they account for 60% of the spinal gliomas; account for 6% of intracranial gliomas. Histology: perivascular pseudorosettes are the most common pattern of tumor cells.

This photo was published in Magnetic Resonance Imaging of CNS Disease: A Teaching File, 2nd edition, D. H. Yock, Jr., 2002, page 665, Case 1083. Copyright Elsevier, 2002. Used by permission.

 

CASE 13 Multiple sclerosis, axial, T2

Forty-year-old woman presents with paresthesias in both legs and feet; a medial rectus palsey on attempted lateral conjugate gaze; CSF shows an increase in gamma-globulin, beta-globulin, oligoclonal bands, and myelin basic protein. Associate Dawson's fingers with MS. MS is myelinoclastic disorder with a loss of the myelin sheath without axonal involvement.

This photo was published in Magnetic Resonance Imaging of CNS Disease: A Teaching File, 1e, D. H. Yock, Jr., 1995, page 205, Case 329. Copyright Elsevier, 1995. Used by permission.

CASE 14 Amyotrophic lateral sclerosis, axial, T2, 2500/90

Twenty-five-year-old man presents with upper and lower motor neuron lesions, bilateral Babinski and Hoffmann signs. ALS does not affect sensory systems; white arrows show corticospinal tracts in the posterior limb of the internal capsule. Upper and lower motor neuron signs are: muscle weakness and atrophy, fasciculations, hyperactive reflexes, fibrillations, and giant motor units are found in the EMG.

This photo was published in Magnetic Resonance Imaging of CNS Disease: A Teaching File, 1e, D. H. Yock, Jr., 1995, page 265, Case 428B. Copyright Elsevier, 1995. Used by permission.

 

CASE 15 Sturge-Weber syndrome, coronal, T1

Forty-year-old man presents with seizures since childhood; patient has a port-wine stain, a facial nevus consisting of a venous angioma of the upper face; calcification (“railroad tracks”) of the second and third cortical layers in the parieto-occipital cortex. SW is also called encephalotrigeminal angiomatosis; patient may present with hemiparesis and mental retardation.

This photo was published in Magnetic Resonance Imaging of CNS Disease: A Teaching File, 1e, D. H. Yock, Jr., 1995, page 553, Case 911. Copyright Elsevier, 1995. Used by permission.

CASE 16 Syringomyelia, sagittal, T1

Fifteen-year-old girl presenting with numbness and weakness in the hands. Numbness results from destruction of the spinothalmic tracts; weakness of the hands results from destruction of anterior horn motor neurons that innervate the intrinsic muscles of the hand; the sensory loss has a cape-like distribution and points to the syringomyelia as the culprit.

This photo was published in Magnetic Resonance Imaging of CNS Disease: A Teaching File, 1e, D. H. Yock, Jr., 1995, page 654, Case 1051A. Copyright Elsevier, 1995. Used by permission.

 

CASE 17 Parkinson disease, axial, SE 2800/45

Seventy-eight-year-old woman presenting with tremor, cogwheel rigidity, and akinesia; arrows point to low intensity lesions in the lateroposterior putamen; the putamen receives the nigrostriatal tract; there is a loss of neuromelanin-containing neurons in the substantia nigra; Lewy bodies are cytoplasmic inclusions that are found in PD.

This photo was published in Magnetic Resonance Imaging of CNS Disease: A Teaching File, 2nd edition, D. H. Yock, Jr., 2002, page 280, Case 454A. Copyright Elsevier, 2002. Used by permission.

CASE 18 Huntington disease; coronal SE 600/20

Fifty-seven-year-old woman with choreoathetosis and confusion; loss of neurons in the head of the caudate nucleus (hydrocephalus evacuo); ventricular and sulcal enlargement. Chromosomal location is chromosome 4p, inheritance autosomal dominant.

This photo was published in Magnetic Resonance Imaging of CNS Disease: A Teaching File, 1e, D. H. Yock, Jr., 1995, page 281, Case 456. Copyright Elsevier, 1995. Used by permission.

 

CASE 19 Porencephaly, coronal, T1, SE 600/14

Ten-year-old girl presents with seizures and a history of strokes; a porencephalic cyst results from ventricular expansion into a site of parenchymal damage (e.g., CVA); the cyst is lined with ependyma and communicated with the ventricular system.

This photo was published in Magnetic Resonance Imaging of CNS Disease: A Teaching File, 1e, D. H. Yock, Jr., 1995, page 430, Case 697. Copyright Elsevier, 1995. Used by permission.

CASE 20 Brain abscess, coronal, T1, 600/15

Eight-year-old boy presenting with headaches and vomiting; may be secondary to otitis media, mastoiditis, or sinusitis, may result in herniation through the tentorial notch, or foramen magnum. 80% may occur in the cerebrum, 20% may occur in the cerebellum, 40% are caused by S. aureus and streptococci.

This photo was published in Magnetic Resonance Imaging of CNS Disease: A Teaching File, 1e, D. H. Yock, Jr., 1995, page 256, Case 412. Copyright Elsevier, 1995. Used by permission.