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.
0:00
Osmotic demyelination syndrome,
0:02
or central pontine myelinolysis can also mimic stroke.
0:07
These patients have profound hyponatremia.
0:10
Frequently, their alcoholics are debilitated,
0:13
and then they have rapid correction of sodium.
0:16
The patients present with encephalopathy,
0:18
pseudo bulbar palsy, spastic quadriparesis,
0:21
sometimes even coma.
0:23
There's oligodendrocyte injury
0:26
and there's restricted diffusion
0:28
due to myelin vacuolization.
0:30
It involves the central pons,
0:33
there can also be extra pontine locations.
0:36
Frequently, the deep gray nuclei
0:37
and subcortical white matter.
0:39
So, here are images of central pontine myelinolysis.
0:42
You have this classic central pons involvement
0:45
with restricted diffusion.
0:46
And just by contrast, this is what an acute
0:48
infarct usually looks like.
0:50
It's usually in the hemipons,
0:52
not in the central pons.
0:54
This is an example of osmotic demyelination syndrome,
0:58
also known as central pontine myelinolysis
1:01
and extra pontine myelinolysis.
1:03
And these are images of a 46-year-old female,
1:07
alcoholic, who was found with altered mental status
1:11
and severe hyponatremia.
1:13
And then, she had rapid correction of her sodium
1:16
and progressed to a comatose state.
1:20
These are the diffusion weighted images
1:23
and the ADC maps.
1:24
And you can see this classic central
1:27
pontine restricted diffusions.
1:29
It's been called a trident configuration
1:33
in the central pons,
1:34
again, that it's indistinction to a hemipons lesion,
1:38
which is what you would see with infarct.
1:40
And then, this patient also has involvement
1:42
of her bilateral lentiform nuclei,
1:45
her caudate nuclei, and the bilateral thalami.
1:49
Let's take a look at the FLAIR images.
1:52
There's extensive FLAIR hyperintensity
1:56
in the same lesions.
1:57
Again, the central pons and the deep grey nuclei,
2:01
including the lentiform nucleus,
2:02
the caudate nucleus, and thalami.
2:05
And this is a classic case of
2:07
osmotic demyelination syndrome.
Case - Osmotic Demyelination Syndrome (Stroke Mimic)
HIDEInteractive Transcript
0:00
Osmotic demyelination syndrome,
0:02
or central pontine myelinolysis can also mimic stroke.
0:07
These patients have profound hyponatremia.
0:10
Frequently, their alcoholics are debilitated,
0:13
and then they have rapid correction of sodium.
0:16
The patients present with encephalopathy,
0:18
pseudo bulbar palsy, spastic quadriparesis,
0:21
sometimes even coma.
0:23
There's oligodendrocyte injury
0:26
and there's restricted diffusion
0:28
due to myelin vacuolization.
0:30
It involves the central pons,
0:33
there can also be extra pontine locations.
0:36
Frequently, the deep gray nuclei
0:37
and subcortical white matter.
0:39
So, here are images of central pontine myelinolysis.
0:42
You have this classic central pons involvement
0:45
with restricted diffusion.
0:46
And just by contrast, this is what an acute
0:48
infarct usually looks like.
0:50
It's usually in the hemipons,
0:52
not in the central pons.
0:54
This is an example of osmotic demyelination syndrome,
0:58
also known as central pontine myelinolysis
1:01
and extra pontine myelinolysis.
1:03
And these are images of a 46-year-old female,
1:07
alcoholic, who was found with altered mental status
1:11
and severe hyponatremia.
1:13
And then, she had rapid correction of her sodium
1:16
and progressed to a comatose state.
1:20
These are the diffusion weighted images
1:23
and the ADC maps.
1:24
And you can see this classic central
1:27
pontine restricted diffusions.
1:29
It's been called a trident configuration
1:33
in the central pons,
1:34
again, that it's indistinction to a hemipons lesion,
1:38
which is what you would see with infarct.
1:40
And then, this patient also has involvement
1:42
of her bilateral lentiform nuclei,
1:45
her caudate nuclei, and the bilateral thalami.
1:49
Let's take a look at the FLAIR images.
1:52
There's extensive FLAIR hyperintensity
1:56
in the same lesions.
1:57
Again, the central pons and the deep grey nuclei,
2:01
including the lentiform nucleus,
2:02
the caudate nucleus, and thalami.
2:05
And this is a classic case of
2:07
osmotic demyelination syndrome.
Report
Faculty
Pamela W Schaefer, MD, FACR
Professor of Radiology, Vice Chair of Education
Massachusetts General Hospital
Tags
Vascular Imaging
Neuroradiology
Neuro
Metabolic
MRI
Head and Neck
Brain
© 2024 Medality. All Rights Reserved.