Case-based review of neuroradiology - the common, the uncommon, and the truly unusual

Neuroradiology is central to modern neurologic practice, yet many clinicians feel uncertain when interpreting complex brain images or deciding which study to order. Every day, questions arise at the bedside: “Is this CT enough, or do I need an MRI with diffusion?” “Is this ring-enhancing lesion a tumor, an abscess, or a subacute stroke?” “Are these posterior white-matter changes PRES or bilateral PCA infarcts?” Misinterpretation can delay treatment, trigger unnecessary procedures, or miss opportunities for intervention in stroke and other emergencies.

This case-based CME activity walks clinicians through a broad spectrum of neuroradiology findings, starting with the fundamentals and progressing to rare, high-yield entities. Through real clinical cases, participants will review how to choose between CT, CTA, MRI, MRA, and MRV; how to distinguish the major MRI sequences (T1, T2, FLAIR, DWI/ADC, post-contrast) at a glance; and how to localize pathology by understanding normal anatomy, including the central sulcus, ventricular system, and major arterial and venous structures.

The course then focuses on pattern recognition: classical acute and subacute infarcts, venous thrombosis, abscesses versus gliomas and metastases, osmotic demyelination, PRES, venous and arterial clot signs, hydrocephalus and level of obstruction, and inflammatory or infectious processes such as meningitis, empyema, and encephalitis. Participants also see “truly unusual” but memorable cases—including atypical stroke mimics, vasculitis, and rare demyelinating syndromes—that improve diagnostic thinking long after the course ends.

By the conclusion of this activity, neurologists and related clinicians will be more confident in interpreting common neuroradiology scans, recognizing uncommon and rare imaging patterns, and differentiating typical from atypical stroke presentations on MRI in time-sensitive clinical scenarios.

Educational Objectives

After completing this activity, learners will be able to:

• Review and interpret common neuroradiology findings on CT and MRI, including normal anatomy and frequently encountered pathologies.
• Recognize uncommon and rare imaging patterns that suggest alternative diagnoses such as infection, demyelination, vasculitis, or metabolic/toxic injury.
• Differentiate typical from atypical stroke presentations on MRI, using DWI/ADC, FLAIR, vascular imaging, and CT features to refine timing and etiology.
• Select the most appropriate neuroimaging modality and protocol for common clinical presentations in neurologic practice.

Who Should Do This Course?

• Clinicians who frequently order or interpret CT and MRI of the brain in emergency or inpatient settings.
• Neurologists seeking a structured refresher on stroke imaging, hydrocephalus, and common neuroimaging pitfalls.
• Providers who want practical pearls for distinguishing tumors, abscesses, infarcts, demyelination, and infections on MRI.
• Trainees preparing for neurology, neuroradiology, or radiology board examinations requiring strong image-based reasoning.
• Multidisciplinary teams (neurology, radiology, emergency medicine, oncology) aiming to standardize their approach to neuroimaging.

Did You Know?

• Acute ischemic stroke accounts for nearly 85% of all strokes, making rapid neuroimaging interpretation critical for time-sensitive reperfusion decisions. (Lancet Neurol. 2019)
• Diffusion-weighted MRI can detect early cerebral ischemia within minutes of symptom onset, with reported sensitivities exceeding 90% in many series.(Stroke. 2018)
• Up to 30–40% of ring-enhancing brain lesions in some cohorts are due to infection rather than neoplasm, underscoring the importance of diffusion and clinical context in differentiating abscess from tumor. (Neuroradiology. 2017)
• Cerebral venous thrombosis accounts for ~0.5–1% of all strokes, but misdiagnosis is common without careful review of venous sinuses and deep veins on MRI/CTV/MRV. (Brain. 2018)
• Posterior reversible encephalopathy syndrome (PRES) is associated with conditions such as eclampsia, hypertensive crisis, autoimmune disease, and cytotoxic therapies, and can manifest with both vasogenic edema and hemorrhage. (Neurology. 2020)
• Osmotic demyelination syndrome most often follows overly rapid correction of chronic hyponatremia and classically involves the central pons, but “extrapontine” lesions in basal ganglia, thalami, and white matter are also recognized.(J Neurol Sci. 2019)

The estimated time to complete this activity is 1 hour.