MRI of the Sick Brain in Children

What this deck covers

MRI of the Sick Brain in Children in twelve illustrated clinical cases with worked explanations – case presentations built around clinical images, radiology, teaching illustrations and real laboratory data, with the reference range beside every value a case quotes. This visual, data-interpretation style of practice suits candidates preparing for MRCPCH AKP in particular, alongside Saudi and Gulf licensing examinations such as the Arab Board, DHA and OMSB. Each case gives you a clinical vignette, four options, the correct answer, and an explanation of why each of the other three is wrong.

The twelve cases, in order

1. Bright on one sequence, dark on another
2. Bright on diffusion, and bright on the map too
3. Many lesions, one illness
4. Small, oval, and all pointing the same way
5. Fever, confusion, and one lobe
6. Morning headache and a widening gait
7. A cyst with a lump in its wall
8. The headache that came with a blocked channel
9. Which child gets the scanner tonight
10. When the contrast earns its place
11. Before the child goes anywhere near the magnet
12. The scan is normal and the seizures are not

What this deck teaches

• Never read diffusion without the ADC map. Bright on DWI and DARK on ADC is restriction and means acute infarction. Bright on both is T2 shine-through and means nothing acute.
• Encephalopathy separates ADEM from a first attack of MS. ADEM is monophasic, encephalopathic, with large ill-defined lesions and deep grey involvement. MS lesions are small, ovoid and perpendicular to the ventricles.
• Enhancing and non-enhancing together IS dissemination in time. Two ages of lesion on one scan satisfies the time criterion without waiting for a second clinical attack.
• A swollen temporal lobe in a febrile child is aciclovir now. Herpes has a predilection for the temporal lobe and insula. Treatment is started on suspicion and never held for the PCR result.
• Midline and solid is not the same tumour as hemisphere and cystic. A solid mass filling the fourth ventricle obstructs CSF and is usually a medulloblastoma. A hemisphere cyst with an enhancing mural nodule is usually a pilocytic astrocytoma, and often curable.
• Haemorrhage that ignores arterial territories is venous. Look at the sinuses. Venous thrombosis is anticoagulated even when it has already bled, because the clot is what is causing the bleeding.

Exam pearls from this deck

• Bright on diffusion AND dark on ADC is acute infarction. Bright on both is not.
• A diffusion image carries T2 weighting. Only a DARK ADC proves restriction.

The twelve worked cases in this deck, with the images and the full explanation of every option, are part of Pediatric Case Review membership. See what is included, or start with the free Pediatric Exam Review Sets.

More from this system: all neurology illustrated case decks · neurology board questions for bank-style drilling · the free Pediatric Exam Review Sets · pediatric reference values.