Metronidazole is a commonly used antimicrobial drug. When used excessively, it can cause encephalopathy. We report the MRI findings in one such case. A 43-year-old male patient was treated with metronidazole for 2 months, for an amebic liver abscess and presented with neurological signs and symptoms. MRI of the brain showed findings consistent with metronidazole toxicity.

Intramedullary spinal cord abscess secondary to dorsal dermal sinus is a rare entity and involvement of the entire length of spinal cord is even rarer. A thorough history with precise clinical localization, a high index of suspicion, Magnetic Resonance Imaging (MRI) of spine and prompt surgical drainage with appropriate antibiotic therapy are key to the eventual outcome and prognosis.

BackgroundDoppler ultrasound is the accepted gold standard for assessing direction of flow in the portal vein (PV). Moreover, it is non-invasive; therefore, it is well accepted by the patients and does not interfere with flow hemodynamics.ObjectivesThe present study was aimed to evaluate the association between color Doppler findings and the severity of portal hypertension in patients with cirrhosis.Patients and MethodsThe study group included 50 patients referred for ultrasound (US) evaluation over a period of six months from March to August, 2007. The patients were divided into three groups (Child’ A, B and C) based on Child Pugh classification. The direction of flow in the main portal vein (hepatopetal or nonhepatopetal) and peak venous velocity (PVV) in the main portal vein were measured and correlated with the presence or absence of ascites, splenomegaly, splenic and esophageal varices (assessed by Doppler US). These findings were correlated with clinical features and laboratory findings (using Child Pugh’s criteria).ResultsThere was significant association between the decrease of peak portal venous velocity (PVV) and the increase in Child Pugh score. Hepatofugal flow was seen only in patients with more advanced disease. There was also significant association between PVV and splenic varices and ascites, while PVV was not affected by the presence or absence of esophageal varices or splenomegaly. Presence of a recanalized umbilical vein (UV) was associated with increased PVV even in advanced disease.ConclusionsColor Doppler is an excellent modality for detecting and characterizing the complex hemodynamics of portal hypertension in cirrhosis and they correlate with the clinical stage of disease.

The susceptiblity effect in magnetic resonance imaging (MRI) has been recognized for long and often has been considered undesirable, producing unnecessary noise. Susceptibility-weighted imaging (SWI) aims at exploiting this effect to provide a different type of contrast that is suited for vascular imaging. We describe five different cases in which SWI was found useful to delineate the underlying ischemia or to arrive at the corect diagnosis.

Lipoma arborescens is a rare non-neoplastic condition that affects the synovial lining of joints and bursae accounting for less than 1% of all lipomatous lesions. Characterized by villous proliferation of the synovium, it is an uncommon cause of intra/periarticular mass presenting as a painless, slowly progressive longstanding swelling, and is sometimes accompanied by intermittent monoarticular effusions. We describe a rare case of bilateral lipoma arborescens in the bicipitoradial bursae in a young male referred for MRI evaluation of spontaneous bilateral elbow swelling. We chose to bring this case to light because of the rare simultaneous involvement of the bicipitoradial bursae bilaterally and the role of MR in providing a definite diagnosis, hence obviating the need for biopsy and avoiding consideration of other complex intra/periarticular masses.