Neuroradiology: Brain, Spine, Head and Neck
Neuroradiology tests rapid triage of stroke and haemorrhage, accurate spinal emergency recognition, and a systematic approach to head and neck lesions.
Brain
- Non-contrast CT excludes haemorrhage in acute stroke; early signs include loss of the insular ribbon, loss of grey-white differentiation and a hyperdense vessel.
- ASPECTS scores middle cerebral artery territory change; a low score predicts poor outcome.
- MRI diffusion-weighted imaging is positive within minutes; apparent diffusion coefficient maps confirm true restriction.
- Lobar haemorrhage in an elderly patient suggests amyloid angiopathy; basal ganglia haemorrhage suggests hypertension.
Spine and head and neck
- Cauda equina syndrome is a surgical emergency: bilateral leg symptoms, saddle anaesthesia and bladder dysfunction require urgent MRI.
- Cord compression from metastasis needs MRI of the whole spine.
- Head and neck nodal levels guide staging; HPV-related oropharyngeal nodes are often cystic.
Worked example
A 65-year-old with sudden right hemiparesis has a hyperdense left middle cerebral artery and loss of the left insular ribbon. This is an acute left MCA infarct. With ASPECTS 8 and a proximal occlusion, thrombectomy may be offered within the appropriate time window.
Traps
- Reporting no acute infarct on a CT performed early; CT may be normal.
- Missing subarachnoid blood in the basal cisterns.
- Forgetting venous infarction, which does not follow arterial territories.