mri and mental disorders seyed kazem malakouti, md faculty of iran university of medical sciences...

Seyed Kazem Malakouti, MD

MRI and Mental disorders

Seyed Kazem Malakouti, MDFaculty of

Iran University of Medical Sciences

Seyed Kazem Malakouti, MD

• intra-axial : in brain or spinal cord tissue• astrocytoma and oligodendroglioma are intra-axial• brain tissue, ventricles

• extra-axial: extrinsic to brain • meningioma and Schwannoma • Epidural, subdural, subarachnoid

Seyed Kazem Malakouti, MD

• Supra tentorial• Infra tentorial• Posterior fossa

Seyed Kazem Malakouti, MD

Seyed Kazem Malakouti, MD

Seyed Kazem Malakouti, MD

Pituitary tumor

Seyed Kazem Malakouti, MD

Pituitary tumor

Seyed Kazem Malakouti, MD

• Virchow & robin space Perivascular space Penetration of subarachnoid into deep brain with capillaries• Small foci isointense to CSF

Seyed Kazem Malakouti, MD

• Hypocampal region in AD

Seyed Kazem Malakouti, MD

Seyed Kazem Malakouti, MD

Normal pressure hydrocephalus

• Gait• Apraxia• Dementia• incontinence

Seyed Kazem Malakouti, MD

Bilateral Pallidal necrosis

• CT scan & MRI slice• CO poisoning

Seyed Kazem Malakouti, MD

Huntington disease

• 64 y.o male• Caudate atrophy• Pallidus atrophy

Seyed Kazem Malakouti, MD

Normal hyperintensity of posterior limb of internal capsule

• 30 y.o• Intensity similar to

cortex in T2• Round, oval hyperinsity

area• Bilateral lesion• Ependemitis granularis,

normal view of hyperintesities : caps

Seyed Kazem Malakouti, MD

Wilson disease

• Globus Pallidus hyperintensity

• Brain stem hyperintensity

Seyed Kazem Malakouti, MD

Seyed Kazem Malakouti, MD

• 36-year-old woman• dysarthria, • axial tremor• ataxia

Seyed Kazem Malakouti, MD

WD– severe dysarthria– dysphonia, – akathisia, – truncal appendicular – tremor, – left hemiparesis– dystonia.

• Serum ceruloplasmin was markedly decreased at 10 mg/dL (normal 18 to 55 mg/dL)

Seyed Kazem Malakouti, MD

WD

• “face of the giant panda” sign that is characteristic of Wilson’s disease

• T2-weighted axial MRI demonstrates the “face of the giant panda” in the midbrain with high signal in tegmentum and normal red nuclei (arrow)

Seyed Kazem Malakouti, MD

• T2-weighted axial MRI reveals the

“face of the miniature panda” in pons with hypointensity of central tegmental tracts (arrow) with hyperintensity of aqueductal opening to fourth ventricle

Seyed Kazem Malakouti, MD

• acoustic schwannoma: ~80% of CPA masses (most common by far)

• meningioma: ~10% of CPA masses (second most common)

• trigeminal schwannoma• facial nerve

schwannoma• ependymoma• metastasis

Seyed Kazem Malakouti, MD

Seyed Kazem Malakouti, MD

• Tegmentum – Periaqueductal gray (PAG) – The periaqueductal gray is the gray matter around the cerebral aqueduct that deals with pain.

• Substantia nigra and red nucleus – There are important components of the sensorimotor system, and play a role in Parkinson’s and dopamine.

Seyed Kazem Malakouti, MD

Seyed Kazem Malakouti, MD

Seyed Kazem Malakouti, MD

• Tectum – The tectum is the dorsal surface of the midbrain. It is responsible for auditory/visual reflexes, like jumping when someone slams a door.

• Tectum includes:– Superior colliculi – The top part, which controls the

visual reflexes

– Interior colliculi - The bottom part, which control the auditory reflexes

Seyed Kazem Malakouti, MD

Werniche encephalopathy

• 33 y.o• Tectum: white arrow, periaquedutal parnchma• Mamillary bodies: white

arrowheads

Seyed Kazem Malakouti, MD

Werniche encephalopaty

• 53 yo• Hyperintensity of

mamillary bodies

Seyed Kazem Malakouti, MD

• FLAIR sequence MRI image at the level of the midbrain increased signal in the periaqueductal gray matter

Seyed Kazem Malakouti, MD

• Axial FLAIR images show abnormal high signal intensity in the mammillary bodies (white arrows)