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Wednesday, May 30, 2007

Epilepsy..........The Chronic Seizure Disorder

There has always been a sort of stigma about Epilepsy and seizures, dating far back into our history. People thought that patients experienceing seizures were possesed. It is the their lack of understanding that leads them to this belief, like all other things. Seizure can be cuased by many things. For the people suffering from them the cause is not as important as a cure or treatment. I know this from a very personal level, as I too have Epilepsy. I am one of the most fortunate, my seizure disorder is very controlable. I take medication that allows me to work and function at a very high level. This is certainly not the case for everyone. The Epilepsy Foundation is continually doing research to find better ways to help thoose who need it. One of the leaders in reaserch is Shands at Jacksonville, FL. When my mother , who was working for the epilepsy fondation of Brevard County, in Florida went to Shands to see there research she was amazed at the progress and the knowledge they had assembled about Epilepsy. I, being in the MRI field see patients every day who have a history of seizures. It is very common. Many people lead very normal lives with epilepsy. So What is Epilepsy?
Threre are many things that someone with seizures should know:
Triggers and Cuases.
1st response to seizure
Newly Diagnosed
Livining with epilepsy
Epilepsy Surgery

This is just a brief overview on a topic that I am far too familiar with feel free to email me with any questions you may have or leave a comment.

Wednesday, May 23, 2007

FDA gadolinium alert

The FDA along with the ACR has stayed on top of the Gadolinium concerns of many, in the last year. This latest update is now asking all of the Gadolinium pharmaceutical companies to change the packaging to warn about NSF. The FDA has provided some information for Healthcare Providers to better understand and to handle the complexities of this patient population. They have also set-up some FAQ for people.

Saturday, May 19, 2007

Please take this survey....Thank You

If you took my earlier survery thanks but I had to start this new one, so please retake it. I appreciate your patients with me. If you are using a differnt Gadolinium contrast than the list leave me a comment please. If you are thinking about changing contrast due to nsf I would be intrested in hearing from you also. Thank you Chris.

What type of Gadolinium are you using?

Poll Picutre


Display Poll Results

Saturday, May 05, 2007

Science of Death

I read this article today. I sounded like pretty cool stuff. I hope one day we can get to this point. Check out this article at Newsweek. I love to hear what think. send me your coments.......

Sturge-Weber syndrome

What is SWS? Sturge-Weber syndrome (SWS) is the association of a facial port-wine stain with abnormal vessels on the surface of the brain (leptomeningeal angioma), ,-->glaucoma , or both. Some people have an isolated intracranial variant, meaning abnormal brain blood vessels with no skin or eye symptoms. SWS does NOT generally run in families. It can affect one side (in about 85%) or both sides (in about 15%) of the body. The presence of a port-wine stain involving the forehead or eyelids raises the suspicion of SWS. These infants and children must be followed closely for other medical issues, including vision problems, epilepsy, and developmental delays.

MR perfusion imaging and MR spectroscopic imaging
can be safely used to characterize the early
hemodynamic and metabolic changes in Sturge-Weber
syndrome. A better understanding of the natural
progression of disease may aid in early diagnosis,
perhaps before development of symptoms and direct
appropriate therapeutic intervention.

Here is a case study from the Idian Journal of Radiology and Medicine

Singh S, Thomas S Department of Radiodiagnosis and Imaging, Christian Medical College and Hospital, Vellore-632004, India.

In the US: According to Nelson's Textbook of Pediatrics, the incidence of SWS is estimated at 1 per 50,000. No regional differences have been identified. The inheritance is sporadic. The incidences of the major clinical manifestations of SWS are listed in Table 1.

Table 1. Clinical Manifestations of Sturge-Weber Syndrome
Risk of SWS with facial PWS 8%
SWS without facial nevus 13%
Bilateral cerebral involvement 15%
Seizures 72-93%
Hemiparesis 25-56%
Hemianopia 44%
Headaches 44-62%
Developmental delay and mental retardation 50-75%
Glaucoma 30-71%
Choroidal hemangioma 40%

Neuroimaging studies: Besides the clinical examination, these have been the procedures of choice to establish the diagnosis. Historically these are skull radiograph, angiography, CT scan, MRI, MRI with gadolinium, and functional imaging with SPECT or positron emission tomography (PET).

Summary of Work-up Findings in Sturge-Weber Syndrome

CSF analysis
Elevated protein

Lack of superficial cortical veins, Nonfilling dural sinuses,Abnormal tortuous vessels

CT scan
Calcifications, tram-track calcifications Cortical atrophy, Abnormal draining veins,Enlarged choroid plexus ,Blood-brain barrier breakdown (during seizures) ,Contrast enhancement

Gadolinium enhancement of LA, Enlarged choroid plexus Sinovenous occlusion, Cortical atrophy Accelerated myelination

Hyperperfusion, early Hypoperfusion, late


Reduced background activity Polymorphic delta activity Epileptiform features

Wednesday, May 02, 2007

Erdheim Chester histocytosis

Today, I scanned a pt who I have been scanning for the last couple of years. We scan her every 3-6months or so. She has been trying different therapy for her Erdheim Chester disease. The most recent, a 6 month course of Chemo. I can say that her scans are markedly improved over the last time we scanned her. I was very impressed. I can say this is the best part about what I do . When I see some one getting better it is a great feeling. When I first saw this patient I was not sure what to think, I know i was worried for her. The Radiologist working that night said to me a few words I'll always remember. He said, " this is the rarest case you will see over and over and over again." I thought it was wierd at the time becuase I knew how true it was. I knew I would be seeing this patient again and again for follow up scans, but I will probally never see another case on non-langerhans histocytosis or Erdheim Chesters Disease. Being in the medical feild is sometimes a double edge sword. What is intresing for us working in it is not so good for you living in it. I want to make that clear. So remember your patient when you are doing rounds, it could very well be your friend, your brother, or your mom. Remember we are all practicing medicine.............................................

Here is some background on the disease.

Tuesday, May 01, 2007


A baby girl born at term
to a 23-year-old
mother was noted to have a
large fluid-filled, skincovered
soft tissue mass
protruding from the
midthoracic region in the dorsal midline. Birth weight was 3.5
kg, and the baby had Apgar scores of 9 at 1 and 5 minutes.
Examination revealed the anterior fontanelle to be soft and
flat, and the patient’s head size was normal. No dysmorphic
features were noted. There was a small sacral dimple. The
infant had no obvious neurological deficits, moved all extremities
equally, and had normal reflexes.
A magnetic resonance imaging (MRI) scan of the brain and
spinal cord revealed a posterior thoracic meningocele with
displacement of the spinal cord into the base of the sac, which
otherwise seemed to be devoid of neural elements. An
MRI scan of the brain and craniocervical junction revealed an
associated Chiari malformation with herniation of the caudal
cerebellum down to the midportion of C1 . The ventricles
were of normal size and configuration.
A repair of the thoracic meningocele was performed on Day
2 of life with release of the circumferential area of spinal cord
tethering at the site of the dural defect. Direct communication
between the meningocele sac and the spinal subarachnoid
space was apparent. Watertight dural and myofascial closure
was then obtained. Because the child’s Chiari malformation
was asymptomatic, expectant management was pursued. A
follow-up MRI scan 3 months after the operation
revealed complete resolution of the previously noted Chiari
malformation, as well as ample CSF space at the foramen
magnum region. A follow-up MRI scan 4 months later revealed
no evidence of recurrence of the Chiari malformation.
The child continues to demonstrate normal neurological function
and is exhibiting appropriate developmental progress.(source)

This is amazing that they can fix the problem in the thoracic spine an the chiari malformation resolves itself. The body is so awesome.

Nuerosurgery online


MRI Nueroarm Video