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Wilson's disease! Defective ATP7B intracellular copper transporter with accumulation of copper in various organs. Consider in a young patient presenting with neuropsychiatric symptoms. Often affects the basal ganglia and thalami (with swelling acutely that later progresses to

Neurosyphilis, a disease in the ascendant in the UK (in 2022 we had the highest number of syphilis diagnoses since 1948!). It has myriad potential manifestations, including cranial neuropathies (here we have bilateral facial and vestibulocochlear nerve enhancement, left

The central tegmental tracts connect the red nuclei and inferior olivary nuclei. Central tegmental tract T2-weighted hyperintensity and diffusion restriction is sometimes seen in young children. We don't know exactly why it occurs or what it implies. It's been described in

Acute encephalopathy with biphasic seizures and late reduced diffusion (AESD) is a rare parainfectious syndrome. It presents in early childhood with two phases of seizure activity punctuated by a brief period of apparent recovery, firstly febrile seizures, later clusters of focal

Autoimmune encephalitis (AE) is caused by antibodies directed against intracellular (group I) or extracellular (group II) neuronal antigens. Group I AE is frequently paraneoplastic. Imaging can be normal at first (particularly for anti-NMDAR AE). When abnormal, limbic

FIG4 is a gene with a role in intracellular transport. Mutations in FIG4 can cause a variety of disorders, including Yunis Varon syndrome, a form of Charcot Marie Tooth disease, and a heterogenous paediatric-onset disease with prominent neurological involvement. This patient with

Superficial siderosis (SS) can be cortical or infratentorial. Cortical SS (cSS) affects the supratentorial sulci while infratentorial SS (iSS) affects the posterior fossa structures and spinal cord, as in this case. Do you see the marked susceptibility lining the surface of the

Patient with a post-traumatic headache. The subtle findings were missed on the initial scan. Can you appreciate the enlargement of the right superior ophthalmic vein (SOV)? Look at the tubular structures just inferior to the superior rectus - levator complexes. On the CTA, you

One of the worst traumas I've seen. Don't ride motorbikes! Craniocaudal atlanto-axial dissociation. Traumatic blunt cerebrovascular injuries; transections of both V3 segments and dissections of the left V2 and left ICA. Hypoxic brain injury (note the diffuse loss of grey-white

We are all familiar with cavernous malformations (CMs) and their typical "popcorn" appearance and haemorrhagic rim. These benign non-neoplastic vascular lesions are seen in approximately 0.5% of people. CMs are composed of dilated thin-walled capillaries with an endothelial

Early Fahr's disease (primary familial brain calcification or PFBC) with calcification in the lentiform nuclei, globi pallidi, dentate nuclei, and corpus medullare. Typically presents with progressive dystonia, parkinsonism, and neuropsychiatric features in adulthood. Most Fahr's

What's your differential for an intraventricular mass in this location? What do you think about this predominantly solid markedly FLAIR hyperintense lesion in the left lateral ventricle? It's non-enhancing and there's no internal haemorrhage or calcification. This turned out to

You could almost walk past this pre-medullary mass on T2 or FLAIR (is it just flow artefact?) but the DWI hyperintensity is striking and there is positive mass effect. This is an epidermoid cyst, a subtype of ectodermal inclusion cyst. These aren't neoplastic; they arise from

How do you explain this tiny focus of diffusion restriction in the body of the right hippocampus? The patient was a confused adult with profound anterograde amnesia. This was transient global amnesia! TGA is a rare, benign, self-limited disorder characterised by failure of

Bilateral medial medullary infarction (BMMI), resembling a heart (or a pair of AirPods, for the technologically inclined). At this level the medial medullary territory is supplied by branches from the anterior spinal artery. Bilateral infarction can occur with occlusion of a

This T7 fracture involves two columns but is it unstable? The Denis three column model would suggest it is, but the reality is more complex. The three column model is now outdated. It doesn’t adequately account for soft tissue injuries, dynamic instability, or neurologic injury,

A young woman presents with acute, painful, monocular left-sided visual loss, worsening over a few days. On MRI we see enlargement, T2 hyperintensity, and enhancement of the intraorbital segment of the left optic nerve. This was acute optic neuritis. In adults, approximately 30%

On a CT neck you see thickening and medialisation of the left aryepiglottic fold, an enlarged left pyriform sinus, and enlargement of the left laryngeal ventricle. What does this mean and what do you need to do next? The next step is a CT chest. These features suggest a left

Well-defined, ovoid, predominantly intraconal mass in the right orbit, displacing the optic nerve and extraocular muscles. T2 hyperintense with dynamic enhancement, patchy and heterogeneous at first with progressive filling on the delayed images These are the typical features of