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.
Case of the Week (Free)
Get a free weekly case delivered right to your inbox.
Dr. Resnick's MSK Conference
Learn directly from the MSK Master himself.
Lower Extremities MRI Conference
Musculoskeletal Imaging
Emergency Imaging
PET Imaging
Pediatric Imaging
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.
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.
Case of the Week (Free)
Get a free weekly case delivered right to your inbox.
Dr. Resnick's MSK Conference
Learn directly from the MSK Master himself.
Lower Extremities MRI Conference
Musculoskeletal Imaging
Emergency Imaging
PET Imaging
Pediatric Imaging
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.
Lesson
Pre-Course Activities
1 topic, 3 min.
Lesson
Introduction to Stroke Imaging
4 topics, 17 min.
Lesson
Noncontrast CT
5 topics, 14 min.
Lesson
CTA Neck
10 topics, 33 min.
Vascular Imaging in Stroke - CTA vs MRA
2 m.Carotid and Vertebral Vasculopathies Overview & Examples of Atherosclerotic Disease
3 m.Case - Atheromatous Disease with Severe ICA Stenosis
4 m.Carotid & Vertebral Artery Dissection Overview & Examples
3 m.Case - Embolic Stroke with ICA Dissection
5 m.Collagen Vascular Diseases Overview - Examples of FMD, Carotid Web
2 m.Case - Fibromuscular Dysplasia (FMD)
5 m.Case - Ehlers Danlos
7 m.Inflammatory Conditions with Stroke Symptoms - Examples of Takayasu's, TIPIC
4 m.Case - Takayasu’s Arteritis
4 m.Lesson
CTA Head
9 topics, 37 min.
CTA Head in Acute Stroke - Source Images, MIPS, Collaterals
4 m.Case - MCA Stem Embolus with Good Collaterals
5 m.Case - MCA Stem Embolus with Poor Collaterals
4 m.Case - Basilar Tip Thrombus
6 m.Circle of Willis Stenoses: Differential Diagnoses
2 m.Case - Moya Moya disease
6 m.Case - Reversible Cerebral Vasoconstrictive Syndrome (RCVS)
5 m.Case - Primary Angiitis of the CNS (PACNS)
7 m.Infectious Causes of Multifocal Circle of Willis Stenosis
2 m.Lesson
CT Perfusion
3 topics, 15 min.
Lesson
MRI (DWI, FLAIR, SWI) of Acute Stroke
3 topics, 14 min.
Lesson
MRA of Head and Neck
6 topics, 18 min.
Lesson
Multifocal Strokes With No Visualized Vascular Abnormality
6 topics, 26 min.
Lesson
Brain Ischemia, Hypoxia, & Death
6 topics, 16 min.
Lesson
Stroke Mimics & Other Causes of Restricted Diffusion
7 topics, 18 min.
Stroke Mimics - Other Causes of Restricted Diffusion
2 m.Case - Seizure (Stroke Mimic)
4 m.Case - MELAS (Stroke Mimic)
3 m.Case - Hypoglycemia (Stroke Mimic)
3 m.Case - Herpes Virus Encephalitis (Stroke Mimic)
4 m.Case - Osmotic Demyelination Syndrome (Stroke Mimic)
3 m.Case - Brain Metastases (Stroke Mimic)
4 m.Lesson
MR Perfusion
8 topics, 17 min.
MR Perfusion - Data, Maps and Uses
4 m.Case - MR Perfusion Target Mismatch (Good Collaterals)
2 m.Case - MR Perfusion Target Mismatch (Poor Collaterals)
3 m.Case - Ischemia Detected Only on MR Perfusion (Case 1)
2 m.Case - Ischemia Detected Only on MR Perfusion (Case 2)
3 m.Arterial Spin Labelling Perfusion - Usage Examples
3 m.Case - ASL Matched Defect
2 m.Case - ASL Showing Tissue at Risk
2 m.Lesson
Subacute Stroke & Differentials
5 topics, 13 min.
0:01
So in this section, we're going to
0:02
talk about brain death protocols.
0:04
First of all, I'd like to stress that
0:06
brain death is a clinical definition.
0:09
It's defined by coma, lack of brainstem
0:12
reflexes, and the inability of a
0:14
patient to breathe on their own.
0:16
That is the definition.
0:18
On EEG, typically you'll see no activity.
0:22
On nuclear medicine scans, you'll see the
0:24
absent intracranial uptake throughout the brain.
0:26
It's called the empty light bulb sign.
0:29
On digital subtraction angiography,
0:31
you see no forward flow beyond
0:34
the internal carotid arteries.
0:36
And then we're going to talk
0:37
about CT, CTA, and MRI, MRA.
0:41
So, the arrows in red are things that
0:44
are quite predictive of brain death.
0:46
Again, on CT, CTA, no opacification arteries,
0:50
distal to the internal carotid arteries.
0:52
On MRA, no flow related enhancement
0:56
of the cerebral arteries, distal
0:57
to the internal carotid arteries.
0:59
Loss of the arterial flow
1:00
voids and T2 weighted images.
1:02
and no intracranial perfusion.
1:05
The items in yellow are pretty good
1:09
predictors, more common in patients
1:11
with brain death than with patients
1:13
with edema who don't have brain death.
1:15
And these are low signal or blooming throughout
1:18
all of the arteries and veins is thought to
1:20
be due from increased oxygen extraction and
1:22
from venous stasis and from mass effect.
1:26
that's great enough to
1:26
cause tonsillar herniation.
1:29
The items in white under CTA and green under
1:33
MRI, MRA, are usually seen, but these can
1:38
be partially reversible and cannot really
1:41
differentiate patients in coma who will go on to
1:44
death versus patients who can partially recover.
1:47
So in CT, CTA, it's diffuse cerebral edema
1:50
and loss of gray white differentiation.
1:52
And on MRI, MRA is T2 hyperintensity
1:55
and swelling in the cortex and deep
1:57
brain nuclei greater than white
1:59
matter with restricted diffusion.
2:02
Same is true of brainstem hemorrhage
2:03
and hyperintensity in the brainstem.
2:06
It may predict a worse prognosis, but it's
2:08
not specifically predictive of brain death.
Brain Death Definition and Protocols
HIDEInteractive Transcript
0:01
So in this section, we're going to
0:02
talk about brain death protocols.
0:04
First of all, I'd like to stress that
0:06
brain death is a clinical definition.
0:09
It's defined by coma, lack of brainstem
0:12
reflexes, and the inability of a
0:14
patient to breathe on their own.
0:16
That is the definition.
0:18
On EEG, typically you'll see no activity.
0:22
On nuclear medicine scans, you'll see the
0:24
absent intracranial uptake throughout the brain.
0:26
It's called the empty light bulb sign.
0:29
On digital subtraction angiography,
0:31
you see no forward flow beyond
0:34
the internal carotid arteries.
0:36
And then we're going to talk
0:37
about CT, CTA, and MRI, MRA.
0:41
So, the arrows in red are things that
0:44
are quite predictive of brain death.
0:46
Again, on CT, CTA, no opacification arteries,
0:50
distal to the internal carotid arteries.
0:52
On MRA, no flow related enhancement
0:56
of the cerebral arteries, distal
0:57
to the internal carotid arteries.
0:59
Loss of the arterial flow
1:00
voids and T2 weighted images.
1:02
and no intracranial perfusion.
1:05
The items in yellow are pretty good
1:09
predictors, more common in patients
1:11
with brain death than with patients
1:13
with edema who don't have brain death.
1:15
And these are low signal or blooming throughout
1:18
all of the arteries and veins is thought to
1:20
be due from increased oxygen extraction and
1:22
from venous stasis and from mass effect.
1:26
that's great enough to
1:26
cause tonsillar herniation.
1:29
The items in white under CTA and green under
1:33
MRI, MRA, are usually seen, but these can
1:38
be partially reversible and cannot really
1:41
differentiate patients in coma who will go on to
1:44
death versus patients who can partially recover.
1:47
So in CT, CTA, it's diffuse cerebral edema
1:50
and loss of gray white differentiation.
1:52
And on MRI, MRA is T2 hyperintensity
1:55
and swelling in the cortex and deep
1:57
brain nuclei greater than white
1:59
matter with restricted diffusion.
2:02
Same is true of brainstem hemorrhage
2:03
and hyperintensity in the brainstem.
2:06
It may predict a worse prognosis, but it's
2:08
not specifically predictive of brain death.
Report
Faculty
Pamela W Schaefer, MD, FACR
Professor of Radiology, Vice Chair of Education
Massachusetts General Hospital
Tags
Vascular Imaging
Neuroradiology
Neuro
MRI
Head and Neck
CT
Brain
© 2024 Medality. All Rights Reserved.