Neuroradiology

08/09/2026

🚨 STROKE TRIGGERED BY HEAD ROTATION?

Don’t just look at the brain.
Look at what happens when the neck moves.

🧠 Clinical Pearl: Bow Hunter Syndrome

A patient with recurrent posterior circulation strokes had:

🔸 Occipitalization of C1
🔸 C1–C2 bony anomaly
🔸 Osteophyte at the C2 transverse foramen
🔸 Recurrent symptoms with head movement

Static angiography didn’t tell the whole story.

🎯 Dynamic DSA did.

The patient turned the head to the LEFT.

Injection on the RIGHT side demonstrated dynamic vertebral artery compression at the C2 transverse foramen.

💡 The diagnosis was made not by looking at the artery at rest—but by watching it disappear with movement.

Think Bow Hunter Syndrome when:

➡️ Posterior circulation strokes keep recurring
➡️ Symptoms are provoked by neck rotation
➡️ There is a C1–C2/CVJ bony abnormality
➡️ Routine vascular imaging is unrevealing

📌 Static imaging shows anatomy.
Dynamic angiography shows the mechanism.

Sometimes, the most important “sequence” in stroke imaging is turning the patient's head.

30/07/2026

Back with an aneurysmal case!

01/06/2026

https://finance.yahoo.com/sectors/healthcare/articles/karnataka-sees-1st-surgical-repair-043000039.html

In a first-of-its-kind for the Karnataka region and among only the 2nd and 3rd such cases treated in India, Manipal Hospital Kanakapura Road has successfully performed surgical repair of ananterior dural tear in 2 patients with decade-long undiagnosed Spinal CSF leaks.

31/05/2026

Net water uptake: a new insight into the ischemic infarct using CT

18/05/2026

Superior cerebellar artery (SCA) aneurysms are exceptionally rare (~0.2% incidence), and fusiform variants are even rarer. 🧠
For ruptured dissecting distal SCA aneurysms, endovascular parent artery occlusion offers a highly effective treatment with low morbidity. 💡

17/05/2026

Flow diversion literally!

05/05/2026

**🚨 Medical Mystery Solved: The Diagnostic Trap of Superficial Siderosis 🚨**
Have you or a colleague ever reviewed a brain MRI and spotted Superficial Siderosis centered specifically around the **Superior Vermis**? 🧠
Often, this finding triggers a frustrating diagnostic loop. Because there is a significant lack of awareness about this specific presentation in both neurology and radiology, patients are frequently put through rounds of repeated, invasive cerebral and spinal angiograms to find the source of the bleeding.
**Here is the crucial practice-changing pearl:** 🛑 Stop the endless angiograms!
🔎 **INSTEAD: Screen the spine to look for an epidural CSF collection.**
The most common, yet frequently missed, etiology for this specific pattern is a **Chronic Type 1a Spinal CSF Leak (also known as a Duropathy or dural defect)**.
By shifting our focus to the spine and screening for that epidural CSF collection, we can finally give these patients the correct diagnosis and spare them from the physical and emotional toll of unnecessary, repeated testing.
Let’s spread the word, close this knowledge gap, and improve patient care! Share this with your colleagues in radiology and neurology. 🩺💡
📸 *Clinical insights and imaging courtesy of Dr. Sharath Kumar GG.*

29/04/2026

Treating the "culprit/vulnerable plaque," not just the "percentage."
Paradoxical carotid stenosis—where the symptomatic side is less severe on imaging than the asymptomatic side—remains a high-risk scenario.
Sequential treatment planned: stabilize the symptomatic lesion first, then address the high-grade contralateral stenosis

27/04/2026

Spinal CSF leak: Snapshot

27/04/2026

A 4-week ordeal, solved in a single afternoon. ✨AWARENESS POST******
​Imagine being completely bedridden for a month. A severe, crushing headache strikes the moment you stand up, only to completely vanish when you lie flat.

​Recently, we saw a middle-aged patient at Manipal Hospital, Kanakapura Road who was living this exact nightmare. She had been seeking answers for four weeks.

Despite multiple consultations and several MRI scans of her brain and spine that were officially reported as "unremarkable," she was still in agony.

She had been given various misdiagnoses, leaving her and her family feeling helpless.
​But sometimes, "normal" scans just require a closer look. 🧠🔍

​When we reviewed her outside MRIs in our clinic, we spotted the incredibly subtle—but definitive—signs of a spinal CSF (cerebrospinal fluid) leak causing Spontaneous Intracranial Hypotension.

The clues were barely there, but to a trained eye, they told the whole story.
​Because the findings were so clear upon review, we didn't waste any time. In that exact same sitting, we took her into the interventional suite and performed a targeted epidural blood patch to seal the leak.

​The most rewarding part? After a short recovery period lying flat, we asked her to stand up. For the first time in a month, the weight was gone. She walked out of the hospital later that afternoon, completely upright and pain-free. 🚶‍♀️🙌

​Stories like this are a powerful reminder of why we do what we do. An "unremarkable" report shouldn't be the end of the road when a patient is suffering.

Finding those subtle signs can literally give someone their life back!
​🏥