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Training Collections
Library Memberships
On-demand course library with video lectures, expert case reviews, and more
Fellowship Certificate™ Programs
Practice-focused training programs designed to help you gain experience in a specific subspecialty area.
Ultimate Learning Pass
Unlock access to our full Course Library and all self-paced Fellowships.
Noon Conference (Free)
Get access to free live lectures, every week, from top radiologists.
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Dr. Resnick's MSK Conference
Learn directly from the MSK Master himself.
Lower Extremities MRI Conference
Musculoskeletal Imaging
Emergency Imaging
PET Imaging
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For Training Programs
Supplement your training program with case-based learning for residents, registrars, fellows, and more.
For Private Practices
Upskill in high growth, advanced imaging areas.
Emergency Call Prep
Prepare trainees to be on call for the emergency department with this specialized training series.
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Wk 3, Case 3 - Review
HIDEInteractive Transcript
Report
Patient History
Antiphospholipid lipid syndrome. Protein C deficiency. Slurred speech, difficulty walking, arm and hand numbness and weakness. The patient had recent gastric bypass surgery and has not been eating well for 2 weeks.
Findings
Brain:
The signal intensity of the brain parenchyma is normal. Gradient echo scans show no evidence of hemorrhage. The diffusion-weighted imaging shows restricted diffusion in the central aspect of the splenium of the corpus callosum. No other areas of restricted diffusion are identified.There are no post gadolinium enhanced images.
MRA of the brain:
Both vertebral arteries, the basilar artery and both carotid arteries are patent. The right anterior inferior cerebellar artery is not seen. There are no areas of vascular stenosis or aneurysm formation.
MR venographic images without contrast show nonvisualization of the entirety of the left transverse sinus. The superior sagittal sinus, straight sinus, and right transverse sinus are normal in appearance. There is an arachnoid granulation seen on T2-weighted scans which is indenting the left transverse sinus.
Impressions
Focal area of restricted diffusion in the splenium of the corpus callosum. The likely etiology is nutritional given the patient’s gastric bypass surgery and poor alimentation (akin to Marchiafava Bignami syndrome). This can also be seen in patients with seizures or epileptic drug changes as well as after trauma, demyelination, or even ischemia (given her antiphospholipid antibody status). Clinical correlation is required. The remainder of the brain is normal.
Case Discussion
Faculty
David M Yousem, MD, MBA
Professor of Radiology, Vice Chairman and Associate Dean
Johns Hopkins University
Joshua P Nickerson, MD
Associate Professor of Neuroradiology
Oregon Health & Science University
Francis Deng, MD
Assistant Professor of Radiology and Radiological Science
Johns Hopkins University School of Medicine
Tags
Neuroradiology
Metabolic
MRI
Brain
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