MRI and Mental disorders Seyed Kazem Malakouti, MD Faculty of Iran University of Medical Sciences Seyed Kazem Malakouti, MD

intra-axial : in brain or spinal cord tissue astrocytoma and oligodendroglioma are intra-axial brain tissue, ventricles extra-axial: extrinsic to brain meningioma and Schwannoma Epidural, subdural, subarachnoid Seyed Kazem Malakouti, MD

Supra tentorial Infra tentorial Posterior fossa Seyed Kazem Malakouti, MD

Pituitary tumor Seyed Kazem Malakouti, MD

Pituitary tumor Seyed Kazem Malakouti, MD

Virchow & robin space Perivascular space Penetration of subarachnoid into deep brain with capillaries Small foci isointense to CSF Seyed Kazem Malakouti, MD

Hypocampal region in AD Seyed Kazem Malakouti, MD

Normal pressure hydrocephalus Gait Apraxia Dementia incontinence Seyed Kazem Malakouti, MD

Bilateral Pallidal necrosis CT scan & MRI slice CO poisoning Seyed Kazem Malakouti, MD

Huntington disease 64 y.o male Caudate atrophy Pallidus atrophy Seyed Kazem Malakouti, MD

Normal hyperintensity of posterior limb of internal capsule 30 y.o Intensity similar to cortex in T2 Round, oval hyperinsity area Bilateral lesion Ependemitis granularis, normal view of hyperintesities : caps Seyed Kazem Malakouti, MD

Wilson disease Globus Pallidus hyperintensity Brain stem hyperintensity Seyed Kazem Malakouti, MD

36-year-old woman dysarthria, axial tremor ataxia Seyed Kazem Malakouti, MD

WD – severe dysarthria – dysphonia, – akathisia, – truncal appendicular – tremor, – left hemiparesis – dystonia. Serum ceruloplasmin was markedly decreased at 10 mg/dL (normal 18 to 55 mg/dL) Seyed Kazem Malakouti, MD

WD “ face of the giant panda” sign that is characteristic of Wilson’s disease T2-weighted axial MRI demonstrates the “face of the giant panda” in the midbrain with high signal in tegmentum and normal red nuclei (arrow) Seyed Kazem Malakouti, MD

T2-weighted axial MRI reveals the “face of the miniature panda” in pons with hypointensity of central tegmental tracts (arrow) with hyperintensity of aqueductal opening to fourth ventricle Seyed Kazem Malakouti, MD

acoustic schwannoma: ~80% of CPA masses (most common by far) meningioma: ~10% of CPA masses (second most common) trigeminal schwannoma facial nerve schwannoma ependymoma metastasis Seyed Kazem Malakouti, MD

Tegmentum – Periaqueductal gray (PAG) – The periaqueductal gray is the gray matter around the cerebral aqueduct that deals with pain. Substantia nigra and red nucleus – There are important components of the sensorimotor system, and play a role in Parkinson’s and dopamine. Seyed Kazem Malakouti, MD

Tectum – The tectum is the dorsal surface of the midbrain. It is responsible for auditory/visual reflexes, like jumping when someone slams a door. Tectum includes: – Superior colliculi – The top part, which controls the visual reflexes – Interior colliculi - The bottom part, which control the auditory reflexes Seyed Kazem Malakouti, MD

Werniche encephalopathy 33 y.o Tectum: white arrow, periaquedutal parnchma Mamillary bodies: white arrowheads Seyed Kazem Malakouti, MD

Werniche encephalopaty 53 yo Hyperintensity of mamillary bodies Seyed Kazem Malakouti, MD

FLAIR sequence MRI image at the level of the midbrain increased signal in the periaqueductal gray matter Seyed Kazem Malakouti, MD

Axial FLAIR images show abnormal high signal intensity in the mammillary bodies (white arrows) Seyed Kazem Malakouti, MD