Unusually Unnerved.

A 47-year-old woman had left-sided facial weakness and swelling for 2 months. These symptoms developed after chemotherapy. What is your diagnosis?

Clival and Paraclival Lesions: A Pictorial Review.

The clivus is a midline anatomical structure in the central skull base. It is affected by a wide range of non-neoplastic, benign and malignant pathologies, some of which typically affect the clivus because of its strategic location and embryological origins. Clival lesions may often be asymptomatic with occasional complaints like headache or cranial neuropathy in few. Cross-sectional imaging techniques, namely, computed tomographic scan and magnetic resonance imaging, thus, play a key role in approximating to the final diagnosis and estimating the disease extent. In this article, we highlight the important imaging features of various clival and paraclival pathologies to facilitate effective diagnosis, therapeutic planning, and management.

Imaging for Plasma Cell Dyscrasias: What, When, and How?

Imaging plays a vital role in the diagnosis, response assessment, and follow-up of patients with plasma cell bone disease. The radiologic diagnostic paradigm has thus far evolved with developing technology and availability of better imaging platforms; however, the skewed availability of these imaging modalities in developed vis-à-vis the developing countries along with the lack of uniformity in reporting has led to a consensus on the imaging criteria for diagnosing and response assessment in plasma cell dyscrasia. Therefore, it is imperative for not only the radiologists but also the treating oncologist to be aware of the criteria and appropriate imaging modality to be used in accordance with the clinical question. The review will allow the treating oncologist to answer the following questions on the diagnostic, prognostic, and predictive abilities of various imaging modalities for plasma cell dyscrasia: a) What lesions can look like multiple myeloma (MM) but are not?; b) Does the patient have MM? To diagnose MM in a high-risk SMM patient with clinical suspicion, which modality should be used and why?; c) Is the patient responding to therapy on follow-up imaging once treatment is initiated?; d) To interpret commonly seen complications post-therapy, when is it a disease and when is the expected sequel to treatment? Fractures, red marrow reconversion?; and e) When is the appropriate time to flag a patient for further workup when interpreting MRI spine done for back pain in the elderly? How do we differentiate between commonly seen osteoporosis-related degenerative spine versus marrow infiltrative disorder?

Case Series of Applications of Resting State Functional MRI in Brain Tumor Surgery: A Novel Technique.

Background The extent of resection for brain tumors is a critical factor in determining the oncologic outcome for a patient. However, a balance between preservation of neurological function and maximal resection is essential for true benefit. Functional magnetic resonance imaging (fMRI) is one of the approaches that augments the neurosurgeon's ability to attain maximal safe resection by providing preoperative mapping. It may not be possible to perform awake craniotomy with intraoperative localization by direct cortical stimulation in all patients, such as children and those with neurocognitive impairment. Task-based fMRI may have limited value in these cases due to low patient cooperability. Methods In this article we present in a case-based format, the various clinical scenarios where resting state fMRI (rs-fMRI) can be helpful in guiding neurosurgical resection. rs-fMRI of the patients has been acquired on Philips 1.5 T system. Seed voxel method has been used for processing and analysis. Conclusion rs-fMRI does not require active patient cooperation to generate useful information and thus can be a promising tool in patients unable to cooperate for task-based studies.