Dr. Pepe’s Diploma Casebook: Case 91 – SOLVED!

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Dear Friends,

Today I am showing images of a 48-year-old man with two brain lesions and a pre-op chest radiograph. What would be your diagnosis regarding the chest?

Check the images below, leave your thoughts in the comments section and come back on Friday for the answer.

Diagnosis:

1. Carcinoma
2. Hydatid cyst
3. Pulmonary infarct
4. None of the above

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The Patient’s view on brain imaging: Austrian Stroke Self-Help Association

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The ESR spoke with Manuela Messmer-Wullen, president of the Austrian Stroke Self-Help Association (SHÖ) and liaison officer for the Stroke Alliance for Europe (SAFE), about the long-term effects of stroke, how it can be prevented and how imaging can help provide a crucial time-saving diagnosis.

ESR: What is the overall aim of your organisation in Austria and what exactly do you do to achieve this goal?

Manuela Messmer-Wullen: Our mission is to inform the public about the burden of stroke, inform them on how to prevent stroke and support those who have been affected by stroke with information regarding their rehabilitation. We also provide support for carers, as well as information on where to find the right rehabilitation facilities, medical support, access to treatments, etc. We lobby, in general, for a better situation for stroke patients and their carers, to give them all a voice in the Austrian healthcare system. I do this work on a voluntary basis, without financial support from the state; projects are financed by individual funders. My personal investment of knowledge, time, energy and power is made in an effort to give stroke patients and their carers a better quality of life in Austria.

ESR: How many members do you have? Who are they?

MMW: In several Austrian states there are different groups run by individuals, therapeutic staff and medical professionals. SHÖ is the umbrella organisation for stroke patients and its membership is made up from many different patient groups who support their members across the country and within different fields.

Manuela Messmer-Wullen, president of the Austrian Stroke Self-Help Association (SHÖ) and liaison officer for the Stroke Alliance for Europe (SAFE)

ESR: Stroke affects an increasing number of people worldwide. Do you think current Austrian health policies are well suited to tackling the issue?

MMW: Not at all, there is no special information pointing out that stroke itself is a brain attack. Stroke is often obscured by the term ‘cardiovascular disease’. This term is used by the media for simplicity and much of the public is unaware that it includes stroke. It would be more helpful to use the individual terms, stroke and heart attack more often. The public has to be informed about the danger of stroke and its possible consequences, like disability. Stroke affects the brain and can damage a lot of functions. Most people have no idea about these facts. Once they have this basic information about stroke, we can start educating them on how to prevent it. Stroke is the only brain disease that can, in certain circumstances, be prevented. People need to be informed of the necessary lifestyle changes.

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The patient’s view on brain imaging: European Federation of Neurological Associations

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The ESR spoke with Donna Walsh, executive director of the European Federation of Neurological Associations (EFNA) about how her organisation supports patients with brain disorders and how well patients are informed about the role of radiology in neurology.

European Society of Radiology: What is the overall aim of your organisation and what exactly do you do to achieve this goal?

Donna Walsh: The European Federation of Neurological Associations (EFNA) is an umbrella group representing pan-European neurology patient groups. Our slogan, ‘empowering patient neurology groups,’ encapsulates our goals as an association. We strive to add capacity to our members, allowing them to be the most effective advocates possible in their own disease-specific areas. EFNA embraces the concept of partnership for progress: working at a high level with relevant stakeholders from the fields of policy, medical, scientific/research, industry, patient partners and other key opinion leaders.

Donna Walsh, executive director of the European Federation of Neurological Associations

Donna Walsh, executive director of the European Federation of Neurological Associations

ESR: How many patient organisations do you represent? How many members do you have? Who are they?

DW: EFNA is an umbrella organisation comprising 19 predominantly pan-European disease-specific neurology patient organisations. These are Dystonia Europe, Euro-Ataxia, European Alliance for Restless Legs Syndrome (EARLS), European Alliance of Neuromuscular Disorders Associations (EAMDA), European Headache Alliance (EHA), European Huntington’s Federation (EHF), European Multiple Sclerosis Platform (EMSP), European Myasthenia Gravis Association (EuMGA), European Network for Research in Alternating Hemiplegia in Childhood (ENRAH), European Polio Union, European Sexual Health Alliance (ESHA), Guillain-Barre & Associated Inflammatory Neuropathies (GAIN), International Brain Tumour Alliance (IBTA), International Bureau for Epilepsy (IBE), Motor Neurone Disease Association (MND) – Europe, Pain Alliance Europe (PAE), Progressive Supranuclear Palsy Association – Europe (PSP-Europe), Stroke Alliance for Europe (SAFE) , Trigeminal Neuralgia Association UK. As you can see, there are also some national organisations who are associate members and some international groups, in the absence of a pan-European association.

ESR: What are the most common brain diseases in Europe?

DW: Brain disorders are very common and will affect one in three of us during our lifetime. They range from very prevalent disorders such as migraine (affecting up to 15% of the population) to very rare disorders. Most people will have heard of multiple sclerosis, dementia, Parkinson’s disease, epilepsy, stroke, etc. But people often forget that sleep, mood, anxiety, addiction and eating disorders are also disorders of the brain. So brain disorders range from the genetic to the degenerative to the muscular and beyond!

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Dr. Pepe’s Diploma Casebook: Case 30 – SOLVED!

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Dear Friends,

Showing MRI images of an 82-year-old woman with partial motor seizures afecting her face.

Diagnosis:
1. Metastasis
2. Meningioma
3. Multiple myeloma
4. None of the above

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Advanced MR imaging helps in interpretation of brain tumours

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Watch this session on ECR Live: Saturday, March 9, 16:00–17:30, Room G/H

Advanced MR imaging techniques such as perfusion and functional imaging have been a great help in improving the diagnosis and staging of brain tumours. Unlike conventional MR techniques, advanced MR techniques can be used to obtain information not only on the morphological, but also on the functional characteristics of tumours.

One of the most common types of brain tumour is glioblastoma, which is highly malignant and has a high cell reproduction rate due to the fact that it is nourished by a large network of blood vessels. According to the American Brain Tumour Association there are two types of glioblastoma: primary glioblastomas, which tend to form and make their presence known quickly by growing aggressively, and secondary glioblastomas, which are also aggressive but show slower growth and only represent 10% of all diagnoses.

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Dr. Pepe’s Diploma Casebook: Case 19 – SOLVED!

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Dear Friends,

The following case depicts MRI images of a 59-year-old woman with rapid cognitive decline, progressive change of character, ataxia and diplopia.

Diagnosis:
1. Posterior reversible encephalopathy
2. Wilson disease
3. Creutzfeldt-Jacob disease
4. None of the above

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Dr. Pepe’s Diploma Casebook: Case 2 – SOLVED!

Dear Friends,

Following the usual pattern of an oral examination (mixed cases from all the subspecialities), I challenge you with the following neuro case, below.

Look out for the answer on Thursday. Good luck!

This week’s patient is a 61-year-old immunocompetent male with progressive disorientation and general weakness

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