Neuroimaging Headache Dementia Incidentalomas DR MARCUS BRADLEY - - PowerPoint PPT Presentation
Health Learning Partnership 13 th September 2017 Neuroimaging Headache Dementia Incidentalomas DR MARCUS BRADLEY CONSULTANT NEURORADIOLOGIST Dr Marcus Bradley Consultant Neuroradiologist Interventional Neuroradiologist Consultant NBT
DR MARCUS BRADLEY CONSULTANT NEURORADIOLOGIST
Health Learning Partnership 13th September 2017 Headache Dementia Incidentalomas
Interventional Neuroradiologist Consultant NBT 2008 – Lead Neuroradiologist 2011 – 2014 Training Program Director 2011– 2017 NHSE Specialised Imaging CRG Specialised 2013– 2016 Chair Imaging Clinical Governance 2014 – SW Senate Assembly Member 2014 –
Neuroradiology Headache Dementia Incidentalomas
Neurointervention
Coiling cerebral aneuryms Thrombectomy for acute stroke
MDTs
Neuro-oncology Epilepsy Paediatrics Neurovascular Dementia Spine Stroke
Tertiary Neuroimaging
Neurosciences Second Opinions Medicolegal
Other procedures
Vertebroplasty Wada Radionuclide
Training
Radiology and non-radiology
Characteristics Pathology
Suspected Cancer: recognition and referral
NG12 updated July 2017 1.9 Brain and CNS
Headache
CG150 updated November 2015 Tension / Migraine / Cluster Menstrual-related Migraine with aura Medication overuse
worsening headache with fever
sudden-onset headache reaching maximum intensity within 5 minutes
new-onset neurological deficit
new-onset cognitive dysfunction
change in personality
impaired level of consciousness
recent (typically within the past 3 months) head trauma
headache triggered by cough, valsalva (trying to breathe out with nose and mouth blocked) or sneeze
headache triggered by exercise
posture)
symptoms suggestive of giant cell arteritis
symptoms and signs of acute narrow angle glaucoma
a substantial change in the characteristics of their headache.
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
Do not refer people diagnosed with tension-type
headache, migraine, cluster headache or medication
reassurance
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
Kernick, BJGP, 2008
Alzheimer’s Disease Fronto-Temporal Dementia
Behavioural Language
Progressive Non-Fluent Aphasia Semantic Logopaenic
Lewy Body Disease Vascular Dementia Prion Disease
Type Recommended diagnostic criteria1 Alzheimer's disease Prefer NINCDS/ADRDA criteria. Alternatives include ICD-10 and DSM-IV. Vascular dementia Prefer NINDS-AIREN criteria. Alternatives include ICD-10 and DSM-IV. Dementia with Lewy bodies (DLB) International Consensus criteria for DLB. Frontotemporal dementia (FTD) Lund–Manchester criteria, NINDS criteria for FTD.
“Diagnosis of subtype of dementia should be made by healthcare professionals with expertise in differential diagnosis using international standardised criteria”
Exclude other pathology Establish subtype MRI vs CT HMPAO SPECT
FTD vs AD vs VaD
DAT SPECT
DCLBD
NOT needed
Moderate / Severe Dementia Diagnosis Clear
Multi-infarct Strategic Infarct Subcortical Atherosclerosis Small Vessel Disease Cerebral Amyloid Angiopathy
40M persistent occipital headache several months- now daily
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
37M head injury in rta 2m ago. Possibly mild concussion Cousin recently had brain tumour. No vom or
headache since injury
55M 8m of daily episodes of deja vu with dread and witnessed vacant expresion and lip smacking. ?fit
41M URGENT PLEASE. ?SOL. 4 day h/o left sided headache with intermittent right visual loss. Never had headaches before. Associated with nausea.
84F coronal views please. memory worsening over the past year. short term memory difficulty. hx of
assessment of dementia type, leading medication
No focal mass lesion, haemorrhage or surface collection seen. There
is moderate generalised involutional change with more focal atrophy affecting the temporal structures bilaterally.
55M dizziness and headache intermittently for 1-2
81M URGENT: known dementia, but recent rapid
walk and follow instructions. More confused. ?subdural
No intracranial haemorrhage or collection. No evidence of recent
temporal volume loss. The left medial temporal lobe is less severely
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?
69M getting regular focal migraines which hadn't had since he was 20
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.
No focal intraparenchymal mass lesion, haemorrhage or surface collection seen. Mild small vessel ischaemic change but with evidence
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.