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The presence of asymmetry in the human cerebral hemispheres is detectable at both the macroscopic and microscopic levels. Asymmetries seen in comparative studies provide strong evidence for phylogenetic origins of brain lateralization. Epidural spinal cord compression (ESCC) refers to compression of spinal cord or cauda-equina by any pathology, most commonly by benign etiology like protruded disc, focal hyper trophy - ossification of ligamentum flavum.
The presentation in neoplastic causes is predominantly slowly progressive paraplegia with or without pain and bowel bladder dysfunction. A 11 yo female presented with abrupt onset of weakness in both lower limbs and low back pain. Adjacent D4 spinous process show abnormal enhancement on post contrast T1 with a minimal similar soft tissue in left spinalis compartment. Extra-osseous Ewing sarcoma (EOES) is an undifferentiated small round-to-oval cell tumor of uncertain origin.
On MRI these lesions commonly appear isointense to muscle on T1, iso to hyperintense on T2 and show moderate enhancement on contrast-enhanced T1 without bony involvement. In management wide surgical resection with follow-up local irradiation and chemotherapy offer the best chance for long-term disease-free survival. Because those are the levels of the spinal cord that deal with the innervation for the arms (cervical) and legs (lumbar). A 58 yo male with recurrent episodic dizziness since long time, accompanied with episodes of blurring of vision.
The Episodic dizziness of patient can be attributed to vertebro basilar hypoplasia and is consistent with clinical diagnosis of  vertebro basilar insufficiency. On TOF MRA Vertebral hypoplasia (VH) is when vertebral artery (VA) is less than 2.0 mm in diameter and Basilar hypoplasia (BH) when basilar is less than its normal average diameter of 3 to 5mm.
Basilar hypoplasia is usually accompanied with unilateral vertebral artery hypoplasia; however, BH with bilateral VH composing vertebrao basilar hypoplasia (VBH) is rare but a significant normal anatomical variation in a patient clinically presenting with vertebro basilar insufficiency where other ENT causes of dizziness are ruled out. Moyamoya is a Japanese word for a "puff" or "cloud of smoke" , and it has been used to refer to an extensive basal cerebral network of small anastomotic vessels at the base of the brain around and distal to the circle of Willis secondary to segmental stenosis or occlusion of the terminal parts of both internal carotid arteries.
Pseudo aneurysms and micro aneurysm are well reported along these collaterals and circle of Willis. It develops after an acute form of arachnoiditis beginning with an inflammatory exudative reaction and progressing into fibrin deposition along nerve root sheaths and arachnoid surfaces. Noninfectious inflammatory etiologies include surgery, intrathecal hemorrhage, administration of intra thecal myelographic contrast, anesthetics and steroids. Normally on axial sections nerve roots in thecal sac should fall freely in the dependent portions. Third (Oculomotor) CN palsy results from damage to the nerve anywhere in its course from the third nerve nucleus in the dorsal mesencephalon, its fascicles in the brainstem parenchyma, the nerve root in subarachnoid space, or in the cavernous sinus or posterior orbit. Third cranial nerve palsy caused by internal carotid - Posterior communicating Aneurysm is one of the most challenging problems facing the ophthalmologist. Urgent neuro imaging and intervention necessary because of the possibility of aneurysmal rupture and intracranial hemorrhage carries a significant risk for morbidity and mortality. Faint ill defined T2 hyper intensity in fronto parietal peri ventricular white matter, bilateral and symmetrical involvement goes in favor of HIV Encephalitis. Bilateral patchy ill defined parietal T2 hyper intensities, confined to white matter, peri ventricular as well as sub cortical white matter.
High signal on Diffusion attributed to prolonged T2 effect, bilateral asymmetrical involvement goes in favor of PML. A syndrome of cognitive, behavioural and motor abnormalities attributed to direct effect of HIV on brain, in absence of opportunistic infection. Atrophy with bilateral symmetric confluent peri ventricular white matter disease, hypodense on CT and T2 hyperintense on MRI is a diagnostic clue. Seen in patients with immune disorders particularly impaired cell mediated immune response.
Predominantly involve fronto parietal white matter; may involve periventricular white matte or sub cortical white matter or both.

Faint enhancement seen on post contrast T1 in follow up MRI of PML pts treated with Anti Retroviral Therapy is associated with increase in their CD4+ count, may indicate favourable prognosis. Imaging wise HIV Encephalitis - Encephalopathy  is usually characterised by bilateral symmetrical Periventricular T2 white matter hyperintensity, An associated diffuse cortical atrophy and ventricular dilatation which are not predominant findings of PML. Clinically HIV Enecephaltis pt present with altered cognition where as PML is associated progressive focal motor and sensory deficits. HIV Encephalitis is attributed to direct effect of HIV on brain parenchyma where as PML is attributed to Demyelinating disease and opportunisting infection occurring in pts with advanced AIDS with severely impaired cell mediated immunity and CD 4 counts.
The role of enteroviruses in the etiology of an acute encephalopathy syndrome of infants and children, prevalent in Nagpur since 1958, was investigated in 1967 and 1968. JavaScript is currently disabled, this site works much better if you enable JavaScript in your browser. A 23-year-old Japanese woman developed mild confusion, gait ataxia, and urinary retention seven days after onset of fever and headache. Incidence of clinically diagnosed influenza patients: The weekly incidence of influenza-like illness (ILI) during three seasons starting from 1996 is summarized in Fig.
The age distribution of the patients reported as ILI during the first quarter of 1999 (the 1st to the 13th weeks) was compared with that during the same period of 1998 (Fig. The Ministry of Health and Welfare notified local health departments of "the overall control plan for influenza in forthcoming winter" on November 17, 1999, requiring influenza prevention to be thoroughgoing (see p.296 of this issue). An association between these asymmetries is inferred but not yet supported by statistical analysis. The right frontal region is often wider than the left, and the left occipital region is often wider than the right, reflect lateralized volume differences in frontal and occipital regions  and is associated with language function in humans, not found in other apes. The cells have pale ampophilic to eosinophilic cytoplasm with indistinct margins and occasional cells show nucleoli the minimal interstitial stroma shows couple of congested blood vessels and appears eosinophillic granular fibrillary in section B the tumor is seen within the inter trabercular space of bony tissue. Primary extraosseous Ewing sarcoma is a rare entity, especially in the spinal epidural site.
The average age of occurrence is around 17 years (range 4-47 years), in contrast to 10 years for skeletal Ewing's sarcoma. Usually the cells have relatively clear and indistinct cytoplasm but contain large quantities of PAS-positive, diastase-digestible material, indicating high concentrations of glycogen.
Spinal cord involvement of primary central nervous system lymphomas: Histopathological examination of 14 autopsy cases. Spinal granulocytic sarcoma (chloroma) presenting as acute cord compression in a non-leukemic patient. There is more mass of nerve cells, bodies, and tracts in order to accommodate the innervation needs of the limbs.
Collagenous strands then develop, adhering nerve roots and septating the subarachnoid space. The lack of normal "fanning" on sagittal views indicates an abnormal position of nerve roots within the sac due to segmental nerve root adherence. Rarely, bilateral if the damage occurs to the third nerve nucleus, frequently accompanied by peri orbital pain or headache. There is an underaction of the superior, inferior, and medial recti muscles and inferior oblique muscle, which may be total or partial. Damage to the third nerve nucleus results in an ipsilateral third nerve palsy with contralateral superior rectus under action and bilateral ptosis. Damage to the third nerve fascicles results in an ipsilateral third nerve palsy with contralateral hemiparesis (Weber's syndrome), contralateral intention tremor (Benedikt's syndrome), or ipsilateral cerebellar ataxia (Nothnagel's syndrome).
Damage to the third nerve within the subarachnoid space produces an isolated third nerve palsy. Damage to the third nerve in the cavernous sinus, superior orbital fissure, or posterior orbit is unlikely to present as isolated third nerve palsy due to the confluence of other structures in these areas. If the palsy fails to resolve in this time frame, repeat the MRI to search for the true etiology.
A patient with isolated third nerve palsy with pupillary involvement should be considered as aneurismal third nerve palsy until proven otherwise.

Recent reports indicated that endovascular management also produce effective neural recovery. Specimens of various body fluids or tissues were collected from 255 patients and examined for the presence of enteroviruses by inoculation in cell culture and in newborn mice. Although the exact etiology of the condition remains poorly understood, it is thought to be associated with infective agents.
Magnetic resonance imaging demonstrated T2 prolongation in the splenium of the corpus callosum and bilateral cerebral white matter.
1-b shows weekly reports of influenza viruses isolated at prefectural and municipal public health institutes (PHIs) in the last three seasons. Among neoplastic the commonest malignancies involving the spinal epidural space are Metastatic lymphoma, Nerve sheath tumor, Meningiomas, Hemangiomas and Metastases from systemic malignancy. EOES, like skeletal Ewing's sarcoma, occurs more commonly in males than females, with a ratio of 2:1. The tumor cells show diffuse, intense membrane reactivity for CD99 (MIC 2) on immuno-histochemical staining. If there is significant enhancement, other causes such as CSF metastases, Guillan-Barre syndrome, and active granulomatous infection should be considered. Pt may or may not complains of double vision because the ptosis obscures the vision in the affected eye. The pupil may be dilated and minimally reactive to light (pupillary involvement), totally reactive and normal (pupillary non-involvement), or may be sluggishly responsive (partial pupillary involvement). Vascular infarct, metastatic disease and demyelinization are the common causes of brainstem involvement.
The main causes are compression of the nerve by an aneurysm of the posterior communicating artery or the basilar artery, and ischemic vasculopathy.
Cavernous sinus involvement may also include pareses of cranial nerves IV, VI and V-1, and an ipsilateral Horner's syndrome. These magnetic resonance imaging abnormalities disappeared two weeks later, and all of the symptoms resolved completely within four weeks.
Rarely round cell tumors which can present with ESCC are primary CNS lymphoma, granulocytic sarcoma and extra-osseous Ewing sarcoma.
Presentation includes back pain in almost in all patients, paresis of one or both legs in approximately 80% with or without sensory disturbances, bladder and bowel dysfunction. Multiple vessels from proximal portion of PCAs are the thalamo striate perforators giving is so called Puff of Smoke appearance contributing to basal cerebral anastomotic or collateral network.
Very high concentration of basic fibroblast growth factor (bFGF) with high angiogenic activity in Csf samples of patients typical imaging findings of Moyamoya disease. Intracranial bleed in the form of subarachnoid bleed,  intra parenchymal or intraventricular bleed common in adults. The common causes of damage in these areas include infective, non infective inflammatory, neoplastic and carotid artery aneurysm. Before AIDS epidemic, PML was rare and was associated with other immune compromised conditions like leukemia, lymphoma, organ transplantation and severe combined immunodeficiency (SCID). The virus isolates included echovirus type 7 (7 patients), coxsackie B2 (3 patients), poliovirus types 1, 2 and 3, echovirus types 1 and 9, coxsackie B1 and several untypable strains. There are strong evidences to support hereditary and familial factors especially among the Japanese. Causes of intracranial haemorrhage in MD are rupture of dilated fragile collaterals or rupture of aneurysms along the circle of Willis and basal cerebral network of collaterals. Supported by other available information on the role of enteroviruses in the etiology of Reye’s and similar syndromes, it is postulated that enteroviruses are the causative agents only in a small proportion of the cases of the Nagpur encephalopathy syndrome.
5b shows the reports of encephalomyelitis patients (including acute encephalitis, encephalopathy, Reye syndrome, and myelitis) reported by about 500 sentinel hospitals in the whole country during the past 12 seasons.

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