Radiologists face the daily challenge of analyzing and interpreting a high volume of images in a timely manner. Minimizing errors, whether perceptual or cognitive in nature, is paramount for high-quality diagnostics and patient care. There are certain areas within the head encountered at routine brain imaging in which the interpreting radiologist is most prone to make perceptual errors. These areas, or "blind spots," include the cerebral sulci, dural sinuses, orbits, cavernous sinuses, clivus, Meckel cave, brainstem, skull base, and parapharyngeal soft tissues. In addition, the use of an inappropriate window width and level for the evaluation of computed tomographic (CT) scans can be a virtual, rather than an anatomic, blind spot. The inclusion of a comprehensive checklist for evaluation of these blind spots as part of every brain imaging study is crucial for avoiding false-negative results. Knowledge of the anatomic features of these blind spots is also crucial, as well as familiarity with the normal CT and magnetic resonance imaging findings in these areas. In addition, the radiologist should be aware of possible interpretation pitfalls that may lead to false-positive results (eg, normal anatomic variants that may be mistaken for pathologic conditions). Finally, a well-developed differential diagnosis will help ensure correct interpretation and appropriate patient treatment.
Serial MRS imaging showed significant improvement in lactate peaks and NAA/Cho ratios that corresponded with clinical improvement after L-arginine therapy. Given this correlation between radiologic and clinical improvement, MRS may be a useful biomarker assessing response to treatment in MELAS.
A 17-year-old male presented with sudden onset of persistent focal neurological symptoms. Magnetic resonance imaging (MRI) demonstrated a nonenhancing white matter lesion that appeared hyperintense on fluid-attenuated inversion recovery sequence and diffusion-weighted imaging, while hypointense on apparent diffusion coefficient mapping corresponding to the patient's clinical features. A smaller subclinical lesion was also present. The patient's history, radiographic findings, and initial hospital course including response to treatment appeared supportive of a stroke diagnosis. However, a rapid recovery from his severe neurological deficits and results of subsequent serologic testing strongly indicated a demyelinating condition. The onset of adolescent multiple sclerosis can present diagnostic and therapeutic challenges, especially when the initial demyelinating event resembles an acute stroke in clinical and radiographic presentation. Every effort should be made to distinguish these diagnoses as early as possible to ensure timely and appropriate management.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.