𧡠Must-Know Signs in Neuroradiology: A Critical Thread for Clinicians & Neurosurgeons
Recognizing key radiological signs in neuroradiology is crucial for accurate diagnosis and management.
The essential "must-know" imaging signs every neurologist, neurosurgeon, and radiologist should recognize. π§ π
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Recognizing key radiological signs in neuroradiology is crucial for accurate diagnosis and management.
The essential "must-know" imaging signs every neurologist, neurosurgeon, and radiologist should recognize. π§ π
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2/ "Sinking Skin Flap Sign" β Syndrome of the Trephined
π Seen in patients post-craniectomy.
π₯οΈ CT/MRI: Sunken scalp flap, underlying cerebral compression.
β οΈ Indicates impaired CSF dynamics & cerebral perfusion.
β Cranioplasty can restore neurological function!
Reference: Shroff MM. Twenty classic signs in neuroradiology: A pictorial essay. Indian J Radiol Imaging. 2009;19(2):135-145.
π Seen in patients post-craniectomy.
π₯οΈ CT/MRI: Sunken scalp flap, underlying cerebral compression.
β οΈ Indicates impaired CSF dynamics & cerebral perfusion.
β Cranioplasty can restore neurological function!
Reference: Shroff MM. Twenty classic signs in neuroradiology: A pictorial essay. Indian J Radiol Imaging. 2009;19(2):135-145.
3/ "Dense MCA Sign" β Early Ischemic Stroke
π Hyperdense middle cerebral artery on non-contrast CT = early thrombus.
π₯οΈ Seen in acute MCA infarcts due to large vessel occlusion.
π¨ Urgent thrombectomy or thrombolysis is needed!
Reference: Koo CK, Teasdale E, Muir KW. What constitutes a true hyperdense middle cerebral artery sign? Cerebrovasc Dis. 2000;10(6):419-423.
π Hyperdense middle cerebral artery on non-contrast CT = early thrombus.
π₯οΈ Seen in acute MCA infarcts due to large vessel occlusion.
π¨ Urgent thrombectomy or thrombolysis is needed!
Reference: Koo CK, Teasdale E, Muir KW. What constitutes a true hyperdense middle cerebral artery sign? Cerebrovasc Dis. 2000;10(6):419-423.
4/ "Dural Tail Sign" β Meningioma
π Thickened, enhancing dura adjacent to a mass.
π₯οΈ MRI with contrast shows smooth, extra-axial, homogeneous enhancement.
β High specificity for meningiomas, but can be seen in metastases.
Shroff MM. Twenty classic signs in neuroradiology: A pictorial essay. Indian J Radiol Imaging. 2009;19(2):135-145.
π Thickened, enhancing dura adjacent to a mass.
π₯οΈ MRI with contrast shows smooth, extra-axial, homogeneous enhancement.
β High specificity for meningiomas, but can be seen in metastases.
Shroff MM. Twenty classic signs in neuroradiology: A pictorial essay. Indian J Radiol Imaging. 2009;19(2):135-145.
5/ "Swirl Sign" β Active Bleeding in Epidural Hematoma
π Hypodense area inside a hyperdense epidural hematoma.
π₯οΈ Seen on non-contrast CT, indicating ongoing arterial bleeding.
π¨ Neurosurgical emergency β Urgent surgery required!
π Hypodense area inside a hyperdense epidural hematoma.
π₯οΈ Seen on non-contrast CT, indicating ongoing arterial bleeding.
π¨ Neurosurgical emergency β Urgent surgery required!
6/ "Hot Cross Bun Sign" β Multiple System Atrophy (MSA)
π Cross-like hyperintensity in the pons.
π₯οΈ Seen on T2-weighted MRI due to degeneration of pontocerebellar fibers.
β οΈ Suggestive of MSA-C (cerebellar type), a progressive neurodegenerative disorder.
π Cross-like hyperintensity in the pons.
π₯οΈ Seen on T2-weighted MRI due to degeneration of pontocerebellar fibers.
β οΈ Suggestive of MSA-C (cerebellar type), a progressive neurodegenerative disorder.
7/ "String Sign" β Carotid Artery Stenosis
π Severe narrowing of the internal carotid artery (ICA).
π₯οΈ Seen on CTA or MRA, indicating critical luminal narrowing.
π¨ High stroke risk! Endarterectomy or stenting may be needed.
π Severe narrowing of the internal carotid artery (ICA).
π₯οΈ Seen on CTA or MRA, indicating critical luminal narrowing.
π¨ High stroke risk! Endarterectomy or stenting may be needed.
8/ "Hummingbird Sign" β Progressive Supranuclear Palsy (PSP)
π Midbrain atrophy resembling a hummingbird on sagittal MRI.
π₯οΈ T1 MRI β Atrophic midbrain with preserved pons.
β οΈ PSP is a parkinsonian-plus syndrome with vertical gaze palsy & postural instability.
π Midbrain atrophy resembling a hummingbird on sagittal MRI.
π₯οΈ T1 MRI β Atrophic midbrain with preserved pons.
β οΈ PSP is a parkinsonian-plus syndrome with vertical gaze palsy & postural instability.
9/ "Eye of the Tiger Sign" β Pantothenate Kinase-Associated Neurodegeneration (PKAN)
π T2 MRI: Central hypointensity (iron accumulation) in the globus pallidus with a hyperintense core.
𧬠Seen in PKAN, a rare neurodegenerative disorder affecting basal ganglia.
π T2 MRI: Central hypointensity (iron accumulation) in the globus pallidus with a hyperintense core.
𧬠Seen in PKAN, a rare neurodegenerative disorder affecting basal ganglia.
10/ "Salt-and-Pepper Appearance" β Paragangliomas
π Heterogeneous flow voids on MRI due to vascular tumor.
π₯οΈ Seen in carotid body tumors, glomus tumors.
β Highly vascular β Angiography & pre-op embolization often required!
π Heterogeneous flow voids on MRI due to vascular tumor.
π₯οΈ Seen in carotid body tumors, glomus tumors.
β Highly vascular β Angiography & pre-op embolization often required!
11/ "Dawsonβs Fingers" β Multiple Sclerosis (MS)
π Periventricular, ovoid white matter lesions oriented perpendicular to the ventricles.
π₯οΈ MRI FLAIR β Seen in MS due to perivenular demyelination.
β Key diagnostic feature for MS (McDonald criteria).
π Periventricular, ovoid white matter lesions oriented perpendicular to the ventricles.
π₯οΈ MRI FLAIR β Seen in MS due to perivenular demyelination.
β Key diagnostic feature for MS (McDonald criteria).
11/ Hockey Stick Sign β Creutzfeldt-Jakob Disease (CJD)
π MRI DWI/T2: Symmetric hyperintensity in caudate nucleus & putamen.
β οΈ Seen in variant & sporadic CJD (prion disease).
π Reference: Vitali P et al. MRI findings in sporadic CJD: The hockey stick sign. Neurology. 2011.
π MRI DWI/T2: Symmetric hyperintensity in caudate nucleus & putamen.
β οΈ Seen in variant & sporadic CJD (prion disease).
π Reference: Vitali P et al. MRI findings in sporadic CJD: The hockey stick sign. Neurology. 2011.
Molar Tooth Sign β Joubert Syndrome
π Axial T2 MRI: Midbrain-hindbrain malformation, hypoplasia of cerebellar peduncles, and "molar tooth" shape.
β οΈ Diagnostic of Joubert syndrome (genetic ciliopathy).
π Reference: Poretti A et al. Molar tooth sign: Diagnostic value in Joubert syndrome. Am J Neuroradiol. 2007
π Axial T2 MRI: Midbrain-hindbrain malformation, hypoplasia of cerebellar peduncles, and "molar tooth" shape.
β οΈ Diagnostic of Joubert syndrome (genetic ciliopathy).
π Reference: Poretti A et al. Molar tooth sign: Diagnostic value in Joubert syndrome. Am J Neuroradiol. 2007
12/ Hockey Stick Sign β Creutzfeldt-Jakob Disease (CJD)
π MRI DWI/T2: Symmetric hyperintensity in caudate nucleus & putamen.
β οΈ Seen in variant & sporadic CJD (prion disease).
π Reference: Vitali P et al. MRI findings in sporadic CJD: The hockey stick sign. Neurology. 2011.
π MRI DWI/T2: Symmetric hyperintensity in caudate nucleus & putamen.
β οΈ Seen in variant & sporadic CJD (prion disease).
π Reference: Vitali P et al. MRI findings in sporadic CJD: The hockey stick sign. Neurology. 2011.
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