Health Learning Partnership 13 th September Neuroimaging. Headache Dementia Incidentalomas DR MARCUS BRADLEY CONSULTANT NEURORADIOLOGIST
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1 Health Learning Partnership 13 th September 2017 Neuroimaging DR MARCUS BRADLEY CONSULTANT NEURORADIOLOGIST Headache Dementia Incidentalomas
2 Dr Marcus Bradley Consultant Neuroradiologist Interventional Neuroradiologist Consultant NBT 2008 Lead Neuroradiologist Training Program Director NHSE Specialised Imaging CRG Specialised Chair Imaging Clinical Governance 2014 SW Senate Assembly Member 2014
3 Glioblastoma Multiforme
4 Schedule Neuroradiology Headache Dementia Incidentalomas
5 Subarachnoid Haemorrhage
6 Neuroradiologists Neurointervention Tertiary Neuroimaging Coiling cerebral aneuryms Neurosciences Thrombectomy for acute stroke Second Opinions MDTs Neuro-oncology Medicolegal Other procedures Epilepsy Vertebroplasty Paediatrics Wada Neurovascular Radionuclide Dementia Training Spine Radiology and non-radiology Stroke
7 Headache Characteristics Pathology
8
9 NICE Guidelines Suspected Cancer: recognition and referral NG12 updated July Brain and CNS Headache CG150 updated November 2015 Tension / Migraine / Cluster Menstrual-related Migraine with aura Medication overuse
10 Evaluate and Consider worsening headache with fever headache triggered by cough, valsalva (trying to breathe out with nose and mouth blocked) or sneeze sudden-onset headache reaching maximum intensity within 5 minutes headache triggered by exercise new-onset neurological deficit orthostatic headache (headache that changes with posture) new-onset cognitive dysfunction symptoms suggestive of giant cell arteritis change in personality symptoms and signs of acute narrow angle glaucoma impaired level of consciousness recent (typically within the past 3 months) head trauma a substantial change in the characteristics of their headache.
11 Consider compromised immunity, caused, for example, by HIV or immunosuppressive drugs age under 20 years and a history of malignancy a history of malignancy known to metastasise to the brain vomiting without other obvious cause
12 Arachnoid Cyst
13 Do not Do not refer people diagnosed with tension-type headache, migraine, cluster headache or medication overuse headache for neuroimaging solely for reassurance
14 Calcified Meningioma
15 2ww Consider an urgent direct access MRI scan of the brain (or CT scan if MRI is contraindicated) (to be performed within 2 weeks) to assess for brain or central nervous system cancer in adults with progressive, sub-acute loss of central neurological function
16 Basal Ganglia Calcification
17 Kernick, BJGP, 2008
18 Vestribular Schwannoma
19 Cerebral Aneurysm
20 Anaplastic Astrocytoma
21 Dementia subtypes Alzheimer s Disease Fronto-Temporal Dementia Behavioural Language Progressive Non-Fluent Aphasia Semantic Logopaenic Lewy Body Disease Vascular Dementia Prion Disease
22
23 AD or SD or FTD or HSE or RTA
24 Diagnosis of subtype of dementia should be made by healthcare professionals with expertise in differential diagnosis using international standardised criteria Type Recommended diagnostic criteria 1 Alzheimer's disease Vascular dementia Dementia with Lewy bodies (DLB) Frontotemporal dementia (FTD) Prefer NINCDS/ADRDA criteria. Alternatives include ICD-10 and DSM-IV. Prefer NINDS-AIREN criteria. Alternatives include ICD-10 and DSM-IV. International Consensus criteria for DLB. Lund Manchester criteria, NINDS criteria for FTD.
25 Imaging in Dementia Exclude other pathology NOT needed Establish subtype Moderate / Severe Dementia MRI vs CT Diagnosis Clear HMPAO SPECT FTD vs AD vs VaD DAT SPECT DCLBD
26 What is Vascular Dementia? Multi-infarct Atherosclerosis Strategic Infarct Small Vessel Disease Subcortical Cerebral Amyloid Angiopathy
27 Parenchymal Haematoma
28 What you tell us
29 40M persistent occipital headache several monthsnow daily
30 Chronic Subdural Haematoma
31 24F worrying features of memory loss and word finding difficulties worse in last 6 months, now disabling as becoming reclusive as unable to hold conversations, bloods- normal, no headaches, no vomiting, well in self,? SOL/ other intracranial pathology
32 37M head injury in rta 2m ago. Possibly mild concussion Cousin recently had brain tumour. No vom or neurology. Hx spondyloarthropathy. Daily headache since injury
33 55M 8m of daily episodes of deja vu with dread and witnessed vacant expresion and lip smacking.?fit disorder.?sol
34 Acute Subdural Haematoma
35 41M URGENT PLEASE.?SOL. 4 day h/o left sided headache with intermittent right visual loss. Never had headaches before. Associated with nausea.
36 84F coronal views please. memory worsening over the past year. short term memory difficulty. hx of HTN. please to assess further. CT will be helpful with assessment of dementia type, leading medication options. many thanks
37 84F report No focal mass lesion, haemorrhage or surface collection seen. There is moderate generalised involutional change with more focal atrophy affecting the temporal structures bilaterally.
38 Pineal Calcification
39 55M dizziness and headache intermittently for 1-2 months. No pattern. Not positional. Feels nauseous. r/o SOL
40 81M URGENT: known dementia, but recent rapid decline. Has had falls. Less coordinated, harder to walk and follow instructions. More confused.?subdural
41 81M report No intracranial haemorrhage or collection. No evidence of recent infarction. There is extensive frontal, parietal and right medial temporal volume loss. The left medial temporal lobe is less severely affected. The imaging is compatible with a diagnosis of AD or FTLD.
42 Cavernous Haemangioma
43 42F head injury oct 16 with concussion. heavy fence post fell onto her head. neck pain and headaches since then, much more acute headache now with some light sensitivity. No fundal changes but could she be scanned urgently?
44 69M getting regular focal migraines which hadn't had since he was 20
45 88F SOON PLEASE - many thanks Coronal views please Cognitive decline over this past year, hx of HTN. Also new intention tremor, is bilateral however. Reduced mobility over the past 2 months. No focal weakness. Hx of breast cancer.? cause? atypical dementia? space occupying lesion? other. with many thanks.
46 88F report No focal intraparenchymal mass lesion, haemorrhage or surface collection seen. Mild small vessel ischaemic change but with evidence of an old infarct in the region of the left globus pallidus. Moderate generalised involutional change with no particular focal atrophic element. There is an extra-axial calcified lesion on the left side of the foramen magnum likely to represent a small meningioma.
47 Questions
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