Emerging Applications of Radiomics in Neurological Disorders: A Review.

Radiomics has achieved significant momentum in radiology research and can reveal image information invisible to radiologists' eyes. Radiomics first evolved for oncologic imaging. Oncologic applications (histopathology, tumor grading, gene mutation analysis, patient survival, and treatment response prediction) of radiomics are widespread. However, it is not limited to oncologic analysis, and any digital medical images can benefit from radiomics analysis. This article reviews the current literature on radiomics in non-oncologic, neurological disorders including ischemic strokes, hemorrhagic stroke, cerebral aneurysms, and demyelinating disorders.

Critical illness-associated cerebral microbleed in a patient with sickle cell disease: A case report and review of the literature.

Critical illness-associated cerebral microbleed (CICM) is a relatively rare and newly described condition. It can occur in critically ill ICU patients and can be secondary to many underlying etiologies. CICM is associated with high mortality and permanent neurologic deficits in surviving patients. Distribution of cerebral microhemorrhages in neuroimaging findings is critical for accurate diagnosis of this condition. Here, we present an ICU admitted patient with sickle cell disease crisis and CICM and will discuss their clinically and radiologically distinct phenomenon followed by a review of current literature.

Imaging of Oculomotor (Third) Cranial Nerve Palsy.

When evaluating a patient with an oculomotor cranial nerve palsy it may be unclear which neuroimaging modality is optimal; MRI, MR angiography, computed tomography, computed tomography angiography, or intraarterial digital subtraction angiography. We discuss the clinical guidelines in the evaluation of such patients and review neuroimaging techniques, outlining the advantages and disadvantages of each.

Functional Magnetic Resonance Imaging (MRI) and MRI Tractography in Progressive Supranuclear Palsy-Like Syndrome.

An 18-year-old woman underwent an uneventful ascending aortic aneurysm repair then developed progressive supranuclear palsy-like syndrome. Extensive neuroimaging including contrasted fat-suppressed cranial and orbital magnetic resonance imaging (MRI), MRI tractography, and functional MRI (fMRI) revealed no clear radiographic involvement except for a single tiny hypoechoic midbrain dot on the T2*-weighted gradient-echo imaging, which is not considered sufficient to account for the patient's deficits. This case attests to the occult nature of this rare and devastating syndrome.

Reversible blindness in cryptococcal meningitis with normal intracranial pressure: case report and review of the literature.

Ocular complications in cryptococcal meningitis (CM) are commonly attributed to elevated intracranial pressure (ICP). We report a case of reversible vision loss complicating AIDS-related CM with a normal ICP. We review other cases of blindness in CM with normal ICP and the potential role of corticosteroids as treatment.

Rathke cleft cyst. MRI criteria for presumptive diagnosis.

OBJECTIVE: To define MRI criteria for the presumptive diagnosis of Rathke cleft cyst (RCC). METHODS: One hundred and three patient MRI scans suggesting RCC performed between January 2005 and January 2011 were retrospectively reviewed for indications, cyst location, T1 and T2 signal intensity, dimensions, encroachment on optic chiasm, enhancement pattern, and stability over a year. RESULTS: Of the 103 patients analyzed, the suggestion of RCC was an incidental finding in 82.5% (n=85) of patients. Headache was the most common symptom in 11.6% (n=12), visual field deficit in 3.8% (n=4), and both headache and visual field deficit in 0.97% (n=1). The cyst was hyperintense on T1 in 55.3% (n=57), hypointense in 27.1% (n=28), and isointense in 17.4% (n=18). The cyst was T2 hyperintense in 57.2% (n=59), and iso-hypointense in 42.7% (n=54). The cyst showed no enhancement in 80.5% (n=83), and a thin marginal enhancement in 19.4% (n=20). The cyst showed a stable appearance in 99% (n=102) of patients after at least one year follow-up MRI study. CONCLUSION: Rathke cleft cysts typically have a cystic appearance with T1 hyperintensity, sometimes with T1 iso- or hypointensity, variable T2 signal, and no or thin marginal enhancement and remain stable in size over time.

Susac syndrome. A differential diagnosis for demyelination.

Susac syndrome is a microangiopathy of unknown origin, probably autoimmune, affecting capillaries and precapillary arterioles of the brain, retina, and inner ear. It is often misdiagnosed as acute disseminated encephalomyelitis or multiple sclerosis. We report the case of a 25-year-old male with Susac syndrome who developed the clinical triad of encephalopathy, visual and hearing problems over the course of a year. The characteristic MRI findings including central corpus callosal involvement and brain infarctions were supported by branch retinal arterial/arteriolar occlusions on fluorescein retinal angiography. Most patients with Susac syndrome will not have the complete clinical triad initially. A very high index of suspicion is required by the clinician and radiologist in patients with any component of the clinical triad so as not to misdiagnose the MRI findings for demyelination. Even if initial ophthalmologic examinations are normal, these patients should be followed up for later development of branch retinal artery occlusions.

Ocular motor and imaging abnormalities of midbrain dysfunction in osmotic demyelination syndrome.

After rapid correction of severe hyponatremia, a 36-year-old man developed osmotic demyelination syndrome (ODS), manifested neurologically by impaired cognition, extremity weakness, bilateral third cranial nerve palsies, and gaze-evoked upbeat and rotary nystagmus. Brain MRI showed restricted diffusion in the rostral midbrain and temporal and parietal lobes but not in the pons. Over several weeks, all neurologic and imaging deficits resolved. This is the first report to document ocular motor abnormalities associated with midbrain dysfunction in ODS.

Optic neuritis is nothing to sneeze at.

A 36-year-old man developed acute visual loss, mimicking an optic neuritis in the left eye. Cranial magnetic resonance imaging revealed a sphenoid sinus mucocele with extension into the anterior clinoid process abutting the left optic nerve. Endoscopic marsupialization of the mucocele led to marked improvement of vision. Sphenoid sinus mucocele is discussed, as is the differential diagnosis of optic neuritis.

Sphenoid sinus mucocele presenting as a third cranial nerve palsy.

A 90-year-old woman developed an acute left third cranial nerve palsy. Brain imaging revealed a left sphenoid sinus mucocele. Endoscopic marsupialization of the mucocele led to complete resolution of the third cranial nerve palsy.