Utility of susceptibility weighted imaging (SWI) and pseudo-continuous arterial spin labeling (pCASL) in diagnosis of falcine venous thrombosis in a child with transient ischemic attack.

Pediatric stroke and transient ischemic attack (TIA) are uncommon but true emergencies with a wide differential diagnosis. Diagnostic imaging plays a critical role in differentiating the diverse range of etiologies. In this case, we report a 3-year-old female with no medical history who developed acute neurological deficits and demonstrate how adjunct advanced imaging including susceptibility weighted imaging (SWI) and pseudo-continuous arterial spin labeling (pCASL) can play a significant diagnostic role in the emergent setting. Imaging was performed with a Philips Ingenia 3.0T MRI. MRI brain, MR angiography (MRA), and phase contrast angiography MR Venography (PCA-MRV) were obtained. pCASL and SWI sequences were performed using SENSE (sensitivity encoding) parallel imaging techniques. MRI/MRA brain showed no restricted diffusion, abnormal T1/T2/FLAIR signal, arterial occlusion, or irregular angioarchitecture. SWI revealed increased susceptibility along the posterior falx cerebri and right posterior parietal and occipital lobes, and pCASL showed decreased blood flow within these same regions. No falcine sinus was visualized on PCA-MRV, but SWI and pCASL findings led to diagnosis of falcine sinus thrombosis and initiation of appropriate treatment. Repeat MRI one month later showed interval resolution of the abnormal SWI findings and a now patent persistent falcine sinus visualized on PCA-MRV imaging. Routine use of SWI imaging on all brain MRIs and addition of pCASL imaging when there is concern for ischemia or infarction in the emergent setting can limit the risk of missed occult diagnoses like a thrombosed falcine sinus.

Magnetic resonance imaging of uveitis.

INTRODUCTION: Uveitis is a term used to describe inflammation of the choroid, iris, or ciliary body, which make up the uveal tract. It can be idiopathic or associated with a systemic disease which may be infectious or noninfectious. With the exception of B-scan ultrasonography, current imaging methods for diagnosing and monitoring uveitis are predominately non-radiologic. Although MRI has been anecdotally shown to detect various inflammatory conditions of the globe, such as posterior scleritis, endophthalmitis, and posterior uveitis secondary to Vogt-Koyanagi-Harada disease, a more comprehensive review of the MRI findings in uveitis of various etiologies is presented here. METHODS: The MRI and CT studies of seven patients with uveitis and the clinical history of three of them (not available in four patients) were reviewed. Etiologies included ankylosing spondylitis, relapsing polychondritis, Vogt-Koyanagi-Harada disease, sarcoidosis, and tuberculosis. RESULTS: Increased gadolinium enhancement of the uveal tract, which is visualized as the enhancing layer immediately deep to the low-signal sclera, was seen on all six MRI studies. Diffusion-weighted imaging of a case with posterior uveitis and subretinal effusions revealed restriction within the uvea and effusions. Two patients had inflammatory nodules adherent to the uvea, two patients had vitreous humor abnormalities, and one patient exhibited proximal perineural and perimuscular spread of enhancement. Uveoscleral thickening and enhancement with a posterior calcification were observed in the patient with chronic uveitis imaged with CT. CONCLUSIONS: Increased uveal tract enhancement is a common finding in patients with uveitis, regardless of anatomic distribution and etiology. MRI can also further evaluate complications of uveitis and help differentiate it from masquerade syndromes.

Cervical Spine Fracture With Vertebral Artery Dissection.

A 51-year-old man presented to a direct-access physical therapy clinic with persistent neck pain for 5 days after a fall in shallow water while surfing. Based on "dangerous mechanism of injury" from the Canadian cervical spine rule as being a high risk factor, the physical therapist ordered radiographs of the cervical spine, which were suggestive of a more serious injury. Computed tomography suggested and magnetic resonance imaging confirmed vertebral artery dissection. J Orthop Sports Phys Ther 2016;46(10):929. doi:10.2519/jospt.2016.0416.